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More than I bargained for

Post date: 17/03/2016 | Time to read article: 3 mins

The information within this article was correct at the time of publishing. Last updated 14/11/2018

I didn’t really want to work for anyone else when I graduated, I just liked the idea of being my own boss and so I found my own premises to set up in. I’m happy still with the decisions and choices I made, although it came with challenges.

Employing staff was a lot harder than I thought it would be but I ended with a mix of experienced staff and brand new people who wanted to learn. My practice manager was a great find. She was local, knew everyone and had recently left a practice when it had changed owners. I should have checked her references, but I was more worried about all the red tape of practice and she was nice, and seemed to know what she was doing.

I had prepared myself for a slow start but my first day was busy and I got busier and busier, with a lot of prosthodontic work. I like making partial dentures and doing crown preps and so I was happy with the way my business was developing. In my heart, I knew that people were only coming to me because I was cheaper than my competitors, but I hoped that with good quality work, I could grow by referral and then gradually increase my fees – see fewer people but charge a bit more.

The pace continued, and I began to rely on my staff more and more to do their job without being overseen. I employed extra support staff to enable me to work two surgeries simultaneously.

Then I received a health fund audit. I thought this was just routine and sent the records as requested. I didn’t check who they were. I didn’t check their HICAPS receipts. I didn’t think about it again, I was too busy.

The worst day of my life was the day a letter arrived suspending my provider privileges and telling me I needed to pay back a huge amount of money for incorrect billing. Incorrect billing? What was that? I had done all of the work. I contacted Dental Protection and they talked me through what to do. I got the patient records and compared with the health fund records – they didn’t match. For example, if I had done a crown for 26, the patient had paid not for a crown, but for 5 fillings instead – same money to me, but not the same to the health fund, not at all.

I spoke to my practice manager to get an explanation. I thought she would be upset or apologetic, but she wasn’t. She said it was ‘standard practice’ and told me not to worry. I asked her to leave. She threatened to destroy my business by bad mouthing me but it didn’t matter, I felt she had already destroyed it through dishonesty.

I couldn’t believe that Dental Protection helped me, but they did. They helped me with a letter to the health fund to explain and they came to a meeting with the health fund and me. As a result of this, I got my provider recognition back, but I did have to pay back an amount for the dodgy billing. That was tough, particularly as it wasn’t me, but I do understand it is my provider number, and so my responsibility.

I now check all of the billings that go through HICAPS, because I can never ever be in this situation again, it’s an extra job, but it’s worth it. My practice has continued to grow as the patients liked me and the work I did. It’s a relief. I would advise anyone to keep an eye on their provider number!

The Dentolegal adviser's perspective
Dr Annalene Weston, Brisbane Office

I remember this case well, Dr N was young, just starting out and a really honest and genuine practitioner. Dr N was devastated to be called dishonest and scared of reputational damage and of losing the practice they had built up and were very much still paying for. I was glad we got such a good result.

I wish I could tell you that this is in isolation, but regretfully, this is not the case. Many practitioners have their provider number used for inappropriate billing without their knowledge and consent, and if this is discovered, it is the provider who is linked to the number who is responsible for the pay back, not the person who has been billing.

The best practical advice we can give is;

  1. Keep an eye on your billings through front office – don’t be scared to check the HICAPS receipts
  2. Make sure you close a provider number if you leave a practice
  3. Also, make sure you contact HICAPS to tell them you have left so they can also close it off and stop claims being put through.

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.

For more detailed advice on any issues, contact us

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