The investigation of a complaint made by an insurance company against a dentist raised serious ethical concerns and identified a pattern of inappropriate billing including:
- time billed for of services exceeding the appointment time;
- billings for patients not recorded in the appointment book;
- billed services not documented or supported in the charts;
- upcoding (billing for a more expensive procedure than provided); and
- unbundling of codes (billing additional fees that would normally be included in a procedure).
The dentist did not provide satisfactory explanations for these discrepancies during the initial meeting with CDSBC, but later took full responsibility for the conduct and revealed that the office manager (who was also the dentist’s spouse) contributed to the practice’s systemic improper billing and also aggressively pressured the dentist to work excessive hours. The College received corroboration that the spouse/office manager had been submitting fraudulent bills for a significant period of time.
The dentist admitted to allowing the conduct and had paid $200,000 to the insurer for overbilled amounts. The Inquiry Panel considered this repayment a mitigating factor in its decision. The College received a medical opinion that the dentist was vulnerable to manipulation by the spouse/office manager.
The dentist is currently not practising and is unlikely to return to practice due to health concerns. The dentist signed a letter acknowledging that the billing and ethical concerns were a serious matter as defined in the Health Professions Act and agreed:
- Not to apply to the College or any other regulatory body in Canada for any category of practising registration for one year;
- Not to repeat the conduct of concern;
- If applying for any category of practising registration to:
- Only practise as an associate or volunteer;
- Enter into a remedial program that includes:
- Successful completion of a multi-day professional ethics course;
- Ensuring billings accurately represent the treatment provided;
- Successful completion of CDSBC’s online dental recordkeeping course;
- Undergoing a chart review six months after returning to practice.
Based on a physician’s letter explaining the negative impact that the publication of the registrant’s name would have on a family member’s mental health, the Inquiry Panel directed that the registrant’s name be withheld from this publication.