Contracts between dentists and funding agencies are absolute – making sure you can honour your side of the bargain is essential...
A practitioner with a capitation-based practice slowed down over the last few years before retirement and many of his patients were pleased when he told them that no work was required at their check-up.
The practice closed and the patients scattered to other local providers of the capitation scheme. Many of them were very upset to be refused registration by one of the new local providers until costly courses of remedial treatment were carried out. Most of these complaints came via the customer service department of the capitation scheme.
Although a substantial proportion of the treatment needed was the responsibility of the retiring dentist, this was not true of all of the treatment the new dentist was recommending. The new dentist’s treatment plans were analysed, tooth by tooth, with the original records and x-rays and a schedule was prepared which differentiated between treatment which resulted from a failure or fault on the part of the original dentist and that which did not.
The new dentist’s fees were also compared to the local average and an offer was made through the company running the capitation scheme and which also had access to the records.
There was some further bargaining, but generally agreement was reached. More than 50 patients were ultimately compensated on the dentist’s behalf. In turn, the practitioner returned a substantial part of the capitation fees he had collected for those patients over the years.
The dentist had done little or no treatment in return for the fees he had received and it was considered unreasonable to allow the dentist to keep all these fees while expecting others to find a sizeable settlement for so many patients.
The contractual arrangements between dentists and third-parties funding treatment define a standard of care that does not allow for variation. Clinicians should review all contracts before signing them to ensure they are able to fulfill their obligations and should consider withdrawing if this ceases to be the case.
These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits dental members enjoy as part of their subscription.
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