Do Not Pass Go...Do Not Collect $200!

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!

As You Staff-Up...Avoid The Dangerous Pitfalls That Can Shut You Down!

With Texas Dentists well on their way to resuming “business as usual” many practices have once again seen the need to staff-up their offices. And while some furloughed team members may be available to fill their former clinical and administrative positions, the majority of Dental facilities now face the daunting task of finding qualified and experienced personnel – who will also mesh well with their existing practice team and culture.

So in addition to the “normal” staffing challenges, you now face ADDITIONAL layers of pitfalls to navigate. Not only will the COVID-19 recovery period play a major role, but emerging discrimination and bias awareness also constitutes another possible minefield. And although each of these new dimensions in the hiring matrix represents positive steps forward, they also mean more obstacles to overcome in staffing your practice!

Now you may be wondering, “What CAN or CAN’T I do???” Fair question, and we’ve put together a BASIC guide to help you get a good team assembled…while avoiding some simple missteps:

RECALLING STAFF MEMBERS:

Before you start the whole “finding new employees” process, most offices will begin to recall furloughed team members. However, remember you must have some sort of criteria and/or process for deciding WHO & HOW you will bring back former employees.

WHO: Beware of possible discriminatory claims if someone is “skipped” in the returning hierarchy. You cannot exclude someone if they have perceived higher risk factors or may be seen as more vulnerable. Plan to have a well-documented rationale for who is recalled to the office at a specific time.

HOW: You cannot “force” someone to return to the practice if they feel uncomfortable or have obligations which prevent them from working in the office. And the Families First Coronavirus Response Act outlines the specific circumstances surrounding the ins-and-outs of negotiating relevant situations.

However, you can require updates and documented one-on-one discussions with the employee. Also maintaining open dialogues and frequent communication with all former staffers about measures you have taken to ensure their safety and protection, helps to both restore confidence and provide a measure of legal compliance.

ALL EMPLOYEES (INCLUDING NEW HIRES):

Now, as healthcare professionals, we’re in a unique position to have a firm handle on the “Dos & Don’ts” of privacy protections and HIPAA stipulations. But that doesn’t mean you can be cavalier as they apply to staff members’ conditions or status. In fact, they may actually have MORE than the average patient in your office! We’ve become accustomed to discussing patients openly among staff members outside the earshot of the public, but the conditions of your own team CANNOT be discussed with other employees – with the possible exception of the HR manager or practice owner. So here’s what you can and can’t do:

CAN:

1. Require daily monitoring, temperature checks and symptom questions

2. Provide mandated COVID-19 tests of all team members

3. Order use of PPE and social distancing guidelines

4. Enact formal COVID-specific policies which each employee must read and sign prior to working in the office

5. Be aware that you must pay employees for the time they spend completing any of these daily requirements and reimburse employees for mandated PPE which you do not provide

CANNOT:

1. Ask any questions regarding their risk factors or health history, unless they choose to VOLUNTARILY offer this information

2. Inquire as to their vaccination status

3. Require employees to receive any of the approved COVID-19 vaccines

4. Fail to reinstate or hire an employee because they refuse to participate in or offer information related to any of these activities

5. Mandate someone return to the office IF their job can be effectively performed remotely…especially if they have outside obligations or exemptions

Now, this last one may seem almost laughable when it comes to a Dental office! But wait…thanks to online portals, remote desktops, VoIPs and video conferencing, many of the daily administrative tasks related to the successful operation of a Dental practice actually CAN be performed remotely. Insurance verifications and submissions, most HR functions, internal marketing and communications tasks, supply ordering, posting documents to patient files, regular management team meetings and financial reconciliations, can all be done from alternate locations…provided you have the proper internet security protocols in place.

These comprise just a brief overview of how to safely bring team members into your office. If you would like to explore more, we highly recommend this concise rundown. And, don’t forget to consult any local mandates, as well as the EEOC guidelines.

Of course, nothing yet exists to replace chairside care, and that’s where good internal communication and detailed DOCUMENTATION of everything will allow you to carefully sidestep those common pitfalls!