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Compliance
We often hear the phrase, “Don’t sweat the small stuff” as a means to give perspective on life. And, in many instances this can be sage advice. After all, we can focus SO heavily on the daily minutia of life we completely lose sight of the “big picture” – whether in our careers, personal life or relationships. Those “nit-picky” little things threaten to overwhelm us or cause us to just give up completely! Which brings us back to our original adage…with one, HUGE, caveat!
How many times have you walked into a professional’s office and casually glanced at all of the diplomas and certificates and “notices” on the walls? Have you ever really LOOKED at them, actually EXAMINED them, read them in their ENTIREITY? Yeah…not many of us do. They’re sort of like scrolling through all that legalese when you install an app or software. Honestly, just seeing “documentation” on the walls is usually enough for most people. We simply assume our doctor or lawyer or dentist is “legit” and knows what they’re doing. But…what if they’re NOT?!? How would you even KNOW?!?
Summer offers an almost-unlimited number of picture-perfect photo opportunities. Heck we even have TWO specialty days this month devoted exclusively to capturing those special moments – first, we had #NationalSelfieDay, then finish up June with #WorldCameraDay! And considering most people now walk around with high-tech digital cameras in their pockets, snapping those Insta-worthy shots is quick and easy….and has become an automatic action for so many people. Yet, that simple action – over in a few seconds – for medical professionals can open a can of worms it may take YEARS to clean up! READ MORE…
This weekend not only marks a rather austere remembrance of the military sacrifices for Memorial Day, but on the polar opposite hand it also heralds the “unofficial” beginning of the summer season. The school days dwindle down to a precious few for those still in session, and endless days of summer camps, vacation plans, family gatherings, adventures with friends and magical twilights, stretch before us. BUT…while students may be out of school, it could be time for YOU to think about going “back-to-school!” Say WHAT?!? No, we’re not looking THAT far down the proverbial road, but instead thinking about protecting your credentials!
Opening any sort of healthcare or medical office involves a major financial investment, between the specialized (and expensive) equipment required for your practice and the infrastructure to support the aforementioned equipment, trained personnel, and administrative operations, it can add up quickly. And that doesn’t even include the actual aesthetics of your office – mundane (yet, important to convey a professional impression) things like chairs, artwork, amenities and décor. We’re talking a SERIOUS chunk of change…but, if you’re forgetting something that’s very inexpensive it can cost you even MORE money!
As countless sources have restated for years, “You can pay now, or you can pay later!” Said in different ways, spanning centuries from Shakespeare to Oscar Wilde, we compiled several apt examples, of which one in particular should deeply resonate with dental professionals!
Even if you’re not an aficionado of board games – especially Monopoly – chances are you STILL know the consequences of drawing the “Do Not Pass Go…Do Not Collect $200” card…and it’s NOT good! And Texas Dentists are about to experience a twist on this concept, thanks to an announced crackdown by the Office of Inspector General.
In a recent announcement, the Texas Health and Human Services Office of Inspector General declared their intention to crack down on Dentists who violate the agency’s policies against Medicaid patient solicitation or inducements. The OIG enforces 1 Texas Administrative Code §371.1669, which prohibits a person from offering any cash, gifts or other items that may influence a potential client's selection of a Medicaid service provider:
“…the last OIG Quarterly Report for 2021 highlighted the agency's efforts to stop this crime. In fact, it is reported on page 5 that a dental provider was caught and punished for it.
"‘The OIG settled a case in September against a Richardson dental provider. The dentist billed Medicaid for services not rendered by altering treatment charts and illegally solicited Medicaid clients by using gift cards. The provider agreed to pay $4,066 in overpayment and $8,133 in penalty to resolve this case.’
“The report then publishes a full-page section on dental solicitation…work(ing) with dental providers to prevent fraud, waste and abuse in Texas Medicaid delivery.
“In its latest endeavor, the OIG is collaborating with the Texas Department of State Health Services (DSHS) to share information about illegal dental solicitation with dentists who participate in Texas Health Steps, which provides free dental and medical checkups to children with Medicaid.
“The outreach effort with DSHS Regional and Local Health Operations is currently underway. OIG staff is training DSHS staff in public health regions across the state, giving them a solid understanding of illegal dental solicitation and the OIG's role in detecting and preventing it. The OIG Communications Team produced educational material to remind Medicaid dentists and their staff of the prohibition against patient solicitation; the material outlines the prohibited behavior and the penalties involved. DSHS will share the information with providers across Texas through a variety of communication avenues.”
In a quick review, the report elaborates that “providers may not offer, and clients may not accept:
Cash, cash equivalents or gift cards in any amount
Free or discounted services for a family member to influence their health care decisions
Transportation, unless it's properly arranged with the client's managed care organization or the Texas Health and Human Services Commission
“The OIG may investigate providers who advertise free transportation on their website or providers who hire people to canvass neighborhoods looking for Medicaid-eligible children and pay drivers to transport children for Medicaid services. Providing goods or services of any value could be considered a violation, but that would typically not be the case for non-cash, low-cost items such as a toothbrush valued less than $10.”
However innocuous this may sound, the agency OIG has put some very real teeth behind their intent to begin policing Dentists in earnest!
”If a provider solicits Medicaid clients, the provider may be found guilty of a Class A misdemeanor and a third-degree felony if the dentist was previously convicted of illegal dental solicitation or was employed by the federal, state or local government at the time. The provider may be subject to disciplinary action by the Texas State Board of Dental Examiners, an injunction, civil penalties of up to $10,000 and possible exclusion as a provider from the Medicaid and CHIP programs.”
In another plot twist, not only can Texas Dentists who use (or advertise) gifts or services to attract new Medicaid patients can incur penalties up to $10,000…not to mention the possibility of earning both jail time AND censure from the TSBDE! Yet, this sword apparently does not cut both ways, since this blacklisted activity for Dentists is perfectly acceptable – and COMMONPLACE – for DMOs.
So, until this blatant inequity is addressed and rectified, Medicaid dental providers should be particularly wary about any of their marketing activities which even imply an inducement. Let’s face it, this is your livelihood and not a game…and a new patient is NOT worth drawing that “Go To Jail” card!
Earlier this month, among the many other celebrations, we also observed #ComplianceOfficerDay…which should come as NO surprise since we are in the compliance business. But, it also gives us a chance to address a question we field regularly: “Yeah, sure, I know…but do I REALLY need a Compliance Officer for my practice?!?”
