Saboteurs Within

Copyright 2003 Journal of the California Dental Association

Dentistry can point to many standards and accomplishments, both old and new, in which it can take pride.

Strong codes of ethics and professional conduct are long-time standards that are at the very foundation of the profession. They remain at the center of the profession’s efforts to govern itself and develop discipline and guidelines for its members. These standards have contributed significantly to the image of the profession.

Additionally, both individually and collectively, dentists have done much to advance efforts aimed at preventing dental disease.

Many dentists can take pride in their efforts to lift the image of the profession through endeavors to fluoridate community water supplies, contributions to community dental health education, participation in community dental health screenings, treatment of children in underserved communities in California or abroad, or direct charitable giving. A new example of this contribution was the recent “Give Kids a Smile” day, which brought dentists, dental students, dental staff, dental association staff, and many others together in a cooperative effort to provide care for countless numbers of children across the country.

Another effort that has grown mightily in recent years is charitable giving aimed not only at providing care for those unable to afford it, but also at advancing research efforts that will help to further control dental disease. Dentistry can be proud of its increasing contributions to oral public health, whether it has been the California Dental Association Foundation, the Pierre Fauchard Academy, the programs or projects of many other organizations such as Su Salud and AYUDA, or individual contributions that have supported dental care or dental research. These achievements are regularly detailed in dental publications. They are worthy of discussion by the profession when debate on dental health issues is before legislators.

However, beyond these limited audiences, dentistry’s standards and accomplishments tend to become invisible to the public. And the public sector is where the saboteurs working within the profession seem to be regularly bashing the image that so many have worked so hard to establish and maintain.

Some of the saboteurs are licensed dentists, some of them are dentists not licensed in California, and others aren’t dentists at all but, when located, are found practicing dentistry or managing practices!

The relative obscurity of the activities of these saboteurs makes it unlikely that they become accountable to the peer review and judicial review procedures of organized dentistry. Yet they ultimately become very visible to the public. Why? They make the headlines all too regularly in newsprint or on television. Their negative contributions to the public good seem to get more attention than the positives that the profession contributes. In the process, these saboteurs tear down the good image so many others continually work so hard to build, because the news stories that describe their deeds always include references to such familiar terms as dentistry, dentist, and dental clinics. The public in many instances is unable to separate these individuals from the profession they are demeaning by their villainous acts.

Of what then are these saboteurs guilty? They design and carry out entrepreneurial schemes that have an objective of fraudulently billing the Medi-Cal system (Denti-Cal) for care not delivered, or for care that is not appropriate or not delivered by properly trained individuals. Dentists who engage in these schemes are of course the worst offenders, as they violate the codes of their profession and are guilty of public fraud. It is equally distressing that some nondentists or unlicensed “dentists” plan or participate in these crimes that bring negative public attention to the dental profession.

Within the past few months, we noted two such reports in the public press. One involved a dental clinic owned and operated by a licensed dentist (who recently had became a new member of a component dental society) that employed a nondentist who produced much of the treatment that was billed to Medi-Cal. In eight months during 2002, investigators apparently uncovered $60,000 in fraudulent Denti-Cal billings before closing the office.

Less than 30 days later, another report titled, “Dental Clinics Charged With Bilking Medi-Cal” appeared. Eight individuals, most of whom the reader of this press report would presume were not dentists, were charged with bilking Denti-Cal out of $380,000 during their operation of four clinics.

Too often we have been hearing of fraudulent business practices in dentistry. New or young dentists, often shouldering heavy educational debt, are often targeted and ultimately become victims of these schemes. They may become victims while engaged in a practice or even after they have left employment in these practices. Fraudulent Denti-Cal billings are often made using the license and Denti-Cal provider numbers of former dentist employees. Young dental graduates must become more vigilant in protecting their ID information, although in many cases it is extremely difficult when they have left an office to protect their personal information from illegal use by people who have previously gained access to it.

Due to the fact that some of the perpetrators of this activity are either unlicensed, or are not even dentists, there is no easy solution to controlling this problem for the dental profession. While dentists are directly responsible for many of these crimes, it is not an activity that the profession has a self-governance mechanism to identify. This fraud is invisible until suspicious practice billing trends, reports from patients or former employees, or suspicions of other dentists in the community lead to audits conducted by state investigators. There are apparently about two dozen active investigations involving suspected dental Medi-Cal fraud cases currently under way in California, according to the press reports we have reviewed.

Fraudulent Denti-Cal billing IS a black eye to the image of the dental profession. The dental profession does not have a good deterrent that will discourage these individuals who work quietly and invisibly until a billing trend is uncovered or a suspicion helps to bring them to justice. Potentially, the best deterrent may be better education of the young professional to identify and avoid this danger.

New members of the profession who are heavily in debt must be counseled or mentored on the importance of protecting their personal identities and resisting the temptation to engage in suspicious or risky business opportunities without carefully evaluating them. Only under those circumstances will we be able to remove the most gullible targets of these saboteurs at work within the dental profession.

Educational efforts will not eliminate the entire problem, but they will at least help to prevent well-meaning members of the profession from being victimized and prosecuted for crimes they did not consciously commit, a scenario that is too often encountered.