There is a clear message that can be taken from a recent decision of the Health Professions Appeal and Review Board (“Board”): dentists are responsible for all billing and claims submitted under their name, even where the dentist does not own the clinic and where the billing is completed by staff members of the clinic without the dentist’s knowledge. In this decision, the Board upheld a decision of the Inquiries, Complaints and Reports Committee (“Committee”) of the Royal College of Dental Surgeons of Ontario to caution a dentist regarding improper treatment charges that were submitted under her name.
The Committee’s decision was the result of an investigation into a patient complaint regarding the billing submitted for services provided by a dental hygienist and which were completed by clinic staff in the dentist’s name. The dentist was not an owner of the clinic, but submitted that she was required to allow dental hygienists to use her stamp as a term of her employment at the clinic.
Based on its review of the documentation obtained through its investigation, the Committee formed concerns about the billing practices of the clinic. Specifically, the Committee was of the view that the use of a certain billing code was inappropriate and that the use of a topical anaesthetic was an integral component of scaling and therefore should not have been billed as a separate procedure.
While the dentist did not deny that the billing submissions were inappropriate, she denied any wrongdoing on her part and argued that the dentist owners of the clinic were ultimately responsible for the billing practices of the clinic. The dentist explained that she had not treated the patient on the dates in question and was not aware that the treatment charges were submitted under her name.
The Committee acknowledged the arguments of the dentist and noted that she was in a difficult position. In the Committee’s opinion, however, these explanations were not sufficient to justify the use of her stamp for inappropriate billing. As a dentist, she had the ultimate responsibility of ensuring that all billings and claims submitted under her name were accurate. The Committee directed that the dentist appear before it to be cautioned regarding her professional obligations, which included that “she should not allow her professional responsibilities to be compromised by anyone, including her employer.”
On review, the dentist argued that the Committee ought to have invited the complainant to expand his complaint to include the dentist owners of the clinic. The Board rejected this argument, and found that, given the nature of the Committee’s concerns regarding the dentist’s practice and the fact that the terms of the caution addressed the specific areas of concern identified, the Committee’s decision was reasonable. The Board also found that the Committee’s investigation was adequate.
This decision serves as a reminder to dentists, as well as other health professionals, that they have a duty to supervise all billing that is being completed in their name by staff members, in order to ensure compliance with their professional responsibilities.
For more information about responding to complaints, reviews by the Health Professions Appeal and Review Board, or health professionals’ employment and professional obligations, please contact us.
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