DrJeff

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On the front, it seems pretty shady. However, it wouldn't suprise me one bit, if the following comes out (of course not via the national media)

1) this guy was running a medicaid clinic basically. After endo tx, many state medicaid plans will only cover lab fabricated cast post and cores

2) You gotta temporize that post space prepped tooth, and for many, many, many of us, in our d-school taught education (mine included), using a paper clip as a temporary post embedded into a temporary crown is taught as normal procedure

3) Billing for a procedure at the time it's done (not necessarily the time it's cemented) is commonplace

4) Many a patient (both private pay/regular insurance/medicaid) has failed their final cement visit and hence walked around with a temporary crown/ temp post and crown for a LONG time (years in some cases)

I can see how this could happen
 
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Aceofspades

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Is this how all medicaid dentists practice? I've always wondered how medicaid dentists can turn a profit with such low reimbursements. Is medicaid fraud the norm?
 

DrJeff

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Is this how all medicaid dentists practice? I've always wondered how medicaid dentists can turn a profit with such low reimbursements. Is medicaid fraud the norm?
There's plenty of NON MEDICAID dentists out there that use a piece of a paperclip as a temporary post while the final one is being fabricated.

If the case plays out as I described above, the doc did nothing out of the ordinary. If he was using a paperclip as his final post under whatever type of final restoration he was placing on that tooth, well then there's an issue.

?? for folks. If you saw an x-ray of a tooth with a parallel post under a crown, would you be able to tell if that post was made out of stainless steel or titanium or was a paperclip???? Think about it:confused::confused::idea:
 

NonTradHopeful

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There's plenty of NON MEDICAID dentists out there that use a piece of a paperclip as a temporary post while the final one is being fabricated.

If the case plays out as I described above, the doc did nothing out of the ordinary. If he was using a paperclip as his final post under whatever type of final restoration he was placing on that tooth, well then there's an issue.

?? for folks. If you saw an x-ray of a tooth with a parallel post under a crown, would you be able to tell if that post was made out of stainless steel or titanium or was a paperclip???? Think about it:confused::confused::idea:
I see your point Dr. Jeff. It seems like some reporters will do anything to break a story. The same applies to prosecutors who are out to try to make a career for themselves. For example, this story:

http://community.pennwelldentalgroup.com/forum/topics/2013420:Topic:11549

Read the whole story (trust me, it's worth it). Stories like this scare the heck out of me, and it also makes me mad as hell.

I think this Dentist is sincere, and unfortunately an aggressive prosecutor used images of the "lavish lifestyle" of the dentist to draw the jury's attention away from the fact that he has broken little or no laws...or just made some minor clerical errors on his records (which were probably not even his fault).

A real shame...
 

NonTradHopeful

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I see your point Dr. Jeff. It seems like some reporters will do anything to break a story. The same applies to prosecutors who are out to try to make a career for themselves. For example, this story:

http://community.pennwelldentalgroup.com/forum/topics/2013420:Topic:11549

Read the whole story (trust me, it's worth it). Stories like this scare the heck out of me, and it also makes me mad as hell.

I think this Dentist is sincere, and unfortunately an aggressive prosecutor used images of the "lavish lifestyle" of the dentist to draw the jury's attention away from the fact that he has broken little or no laws...or just made some minor clerical errors on his records (which were probably not even his fault).

A real shame...

Here is a noteworthy quote from the dentist:

"I believe that any dental office in the United States, if truthful, would indicate that billing mistakes are made; however, the government's position was that these errors were not mistakes, but the errant claims were submitted to be paid for more than I was entitled. Interestingly, there was evidence presented that the errors went both ways. There were services that were provided that were not billed."

The gov't didn't give a crap that some of the procedures were underbilled, only that some where overbilled. If an average was taken of over versus under billed procedures, I'm sure people would see that his practice was not trying to bilk the medicaid system out of money. Unfortunately, this is not how the law works...only over billed procedures (over billed because of CLERICAL ERRORS!!) are focused on, and and overall average of over versus under billing is not taken.

Once again, a real shame...and something for all dentists to be mad about (and learn from).
 

DrJeff

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Here is a noteworthy quote from the dentist:

"I believe that any dental office in the United States, if truthful, would indicate that billing mistakes are made; however, the government’s position was that these errors were not mistakes, but the errant claims were submitted to be paid for more than I was entitled. Interestingly, there was evidence presented that the errors went both ways. There were services that were provided that were not billed."

The gov't didn't give a crap that some of the procedures were underbilled, only that some where overbilled. If an average was taken of over versus under billed procedures, I'm sure people would see that his practice was not trying to bilk the medicaid system out of money. Unfortunately, this is not how the law works...only over billed procedures (over billed because of CLERICAL ERRORS!!) are focused on, and and overall average of over versus under billing is not taken.

Once again, a real shame...and something for all dentists to be mad about (and learn from).
+1!!!

If an insurance company, BY THEIR OWN ERROR, overpays you on a claim, they're on you for repayment quickly (there's argueably a legal statute that if the overpayment is because of THEIR error that they can't ask for repayment), but if because of THEIR error, they underpay/don
t pay, it's very, very, very often a long, ardous process to get the full amount that you/your patient is legally entitled to :mad:
 

Daurang

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Dr. Jeff,

What about when the insurance company by error send the payment check to the patient instead of you? The patient then cash the check and never returns. Is that your problem or the insurance problem to go after the patient?
 

DrJeff

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Dr. Jeff,

What about when the insurance company by error send the payment check to the patient instead of you? The patient then cash the check and never returns. Is that your problem or the insurance problem to go after the patient?
We get that semi-frequently as the plan that one of the CT Casino's has (and my practice has maybe 50 or so patient's employed by them) sends the check directly to the patient, and then we send the bill to the patient. *Most* people get the idea that if they recently had some work done, and then their ins company sends them a decent sized check, that it's probably not for their own spending joy, but to pay their bill. We have had a few people though who cashed that $1000 or so check after a large procedure and then spent it all, and then wondered why we keep sending them statements that they owe us :rolleyes: At least with this ins company, once they've cut the check to their client (our patient) they're financial responsibility has been met, and it's our problem to collect upon it.
 
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question for dr jeff, why don't dentists just charge upfront and get patients to deal w/ the insurance companies. i grew up in canada, and most dentists that i know do this. that way they have no headache of extra paperwork. my dentist will fill out the insurance claim form for me, then i pay up front, send in the claim form to the insurance company, and get paid back within 2-3 weeks. sounds like a good idea to me vs all this extra headache of spending time collecting money from patients.
 

DrJeff

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question for dr jeff, why don't dentists just charge upfront and get patients to deal w/ the insurance companies. i grew up in canada, and most dentists that i know do this. that way they have no headache of extra paperwork. my dentist will fill out the insurance claim form for me, then i pay up front, send in the claim form to the insurance company, and get paid back within 2-3 weeks. sounds like a good idea to me vs all this extra headache of spending time collecting money from patients.
You just described the classical fee for service type practice. There are some practices that do indeed handle billing that way. Many though, especially practices where insurance makes up a significant percent of payments will bill out the the ins company first and then collect the balance from the patient after.
 

mike3kgt

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question for dr jeff, why don't dentists just charge upfront and get patients to deal w/ the insurance companies. i grew up in canada, and most dentists that i know do this. that way they have no headache of extra paperwork. my dentist will fill out the insurance claim form for me, then i pay up front, send in the claim form to the insurance company, and get paid back within 2-3 weeks. sounds like a good idea to me vs all this extra headache of spending time collecting money from patients.
:soexcited:

You are way ahead of the pack my friend. Now if you can implement this philosophy is up to your technical skills and your personality and communication ability.
 
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DrJeff, the posts were the paperclips. According to news, they were apparantly cemented, covered in composite and , in some instances, a crown. (Usually non-precious, as seems to be standard for medicaid patients. I guess something's better than nothing...) Now, you and I know both know the post spiel : the only function of posts is for retention of the final restoration, they do not contribute to resistance. As a matter of fact, it could be argued that most types of posts can actually weaken the remaining tooth structure, introducing the risk of intra-radicular fracture to root-canal-treated teeth. We both know there is quite a bit of difference in the strength of , say, para-posts (the cheapest stuff on the market) and your standard office grade paperclip. So, if these bits of paperclips were purposely cemented in RCT teeth, is that acceptable or not? And why?