24 September 2012
Medicare – Chronic Dental Disease Scheme
The Chronic Dental Disease Scheme (CDDS) has been available for utilisation since November 2007. The dental component of the scheme was intended to provide dental services to those patients suffering from chronic illnesses, whereby this illness has deleteriously impacted on their oral health.
The Scheme was closed to new patients as from Saturday 8th September 2012, and all treatment for existing CDDS patients must be completed by Friday 30th November 2012.
Section 10 Audits Suspended in June 2012
Enacted legislation sets out the obligations of the scheme for both the referring medical and treating dental practitioner, and as the scheme gathered momentum; Medicare became aware of some discrepancies in the administrative and claiming processes and commenced an audit of selected practitioners.
Four areas of ‘abuse’ of the CDDS were initially identified;1
1. Failure to lodge a treatment plan with the referring medical practitioner prior to the commencement of treatment
2. Failure to provide the patient with a written treatment plan prior to the commencement of treatment
3. Failure to provide the patient with a financial statement prior to the commencement of services
4. Claiming of items prior to their completion, for example; claiming for a crown at the preparation not the fit appointment, or more seriously, committing fraud by claiming for treatment not provided.2
A determination of non-compliance results in the requirement by law for a provider to refund all monies claimed in non-compliant cases to Medicare. The treating practitioner is 100% liable for repayment regardless of their working/contractual arrangements. 20 patients are audited in the first instance, however, if a determination of non-compliance is reached, the audit may be expanded to encompass all patients treated under the CDDS.
Many parties were unhappy with the nature and severity of the audits, ultimately leading to a Senate Motion on 24 November 2011 closely followed in February 2012 by a Private Members Bill from Peter Dutton to address these concerns.
Discussions in Senate on 16 February 2012, led to statement from Senator Kim Carr, the Minister for the Department of Human Services which was released at the end of May 2012. In essence, he has indicated that the Government is reviewing the arrangements in place at the inception of the Chronic Dental Disease Scheme in 2007, with a view to consider amending these to allow greater flexibility in compliance arrangements. If changes are made, then all audit findings will be reviewed with these changes applied retrospectively. He has also advised that this MAY not change the findings.
The Department of Human Services has written to the effected dentists to advise them of this review, and in practical terms, it means that all activity relating to Section 10 audits is on hold including debt recovery.
Dental Protection has always advised that practitioners approach participation in the audit in a manner which is open, reasonable, conciliatory and co-operative, as our unique worldwide experience of similar arrangements has shown us that adopting this strategy invariably yields the best results.
Legal Costs Not ‘Capped’ Under the Policy
The MDANI Dental Indemnity Policy has a $20,000,000 the aggregate for all matters for which you seek indemnity under the policy. The maximum amount of indemnity includes legal costs. Sub-limit of $500,000 in the aggregate applies for legal costs and costs orders arising out of investigations and inquiries, allegations of sexual misconduct or criminal conduct, allegations of academic misconduct for students and legal costs seeking an Apprehended Violence Order.
Click here to view the policy.
Practitioner Review Program
The Department of Human Services has indicated that investigations will be undertaken regarding ‘inappropriate practice’ by practitioners utilising the CDDS. ‘Inappropriate practice’ is defined as conduct in connection with rendering or initiating services that would be unacceptable to the general members of the dental profession
Click here to read about this 5 stage process
What are the Guidelines and Requirements of CDDS?
Click here for explanatory notes on the scheme.
Click here for information for dentists and dental specialists providing dental services under CDDS.
Click here to download the Department of Health and Ageing Medicare Benefits Schedule Dental Services.
Click here to download a Checklist for Dental Practitioners to ensure compliance.
Click here to read DPL's previous CDDS guidance for dentists or click here to read to read DPL's previous CDDS guidance for hygienists, therapists and OHTs.
1. Subsection 10(2) of the Determination states that: An item in Schedule 1 applies to a dental service included in the course of treatment only if, before beginning the course of treatment, the eligible dentist, eligible dental specialist or eligible dental prosthetist:
(a) gave to the eligible patient, in writing:
(i) a plan of the course of treatment; and
(ii) a quotation for each dental service and each other service (if any) in the plan; and
(b) gave a copy or written summary of the plan to the general practitioner who referred the patient for dental services.
2. See 1.