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Dental Protection successful in challenging “irrational and unfair” Practitioner Services decision

08 March 2018

Dental Protection has successfully challenged the actions of Practitioner Services of NHS National Services Scotland in a Judicial Review over the recovery of alleged overpayments.

Following a review of a small number of clinical records, Practitioner Services alleged that due to insufficient detail within the records, the claims a Dental Protection member had submitted could not be supported. Practitioner Services therefore sought the recovery of the claims made.

Prior to seeking recovery Practitioner Services permitted the dentist to review her own records and provide comments on the findings.

Following her own review of over 5,000 claims, the dentist concluded that the detail in the records in relation to some claims did not satisfy Practitioner Services’ requirements for making a claim. The dentist voluntarily offered to repay over £10,000. Practitioner Services chose to disregard the dentist’s review of her own records and informed her that they intended to recover over £71,000 and then proceeded to withhold payments by instalment from her monthly schedule with immediate effect.

Dental Protection instructed solicitors to act for our member and a petition for Judicial Review of the actions of Practitioner Services was raised. The petition was granted on 28 February 2018 and the actions of Practitioner Services were found to be ‘patently irrational and unfair’ and the decision to act as it did was a ‘material error of law’. The Court criticised the actions of Practitioner Services for disregarding without explanation the dentist’s own extensive review and to instead proceed on the basis of an extrapolation exercise based on a very small number of records. The sum of £48,000 was recovered before the matter came to the attention of the Court.

Helen Kaney, Head of Dental Services, Scotland at Dental Protection said:

“In this case, Practitioner Services were found to have misapplied the regulations and acted unfairly and irrationally. It is important that payment verification processes are now reviewed to ensure they are fair and that, in future, Practitioners Services acts in accordance with the law when attempting to recover overpayments.

“Dental Protection would urge all dentists to ensure their records are sufficiently detailed in order to justify any claims made to Practitioner Services.”

Raj Rattan, Dental Director at Dental Protection added:

“Dental Protection strives to look after the interests of our members and this Judicial Review is an excellent example of that. We will defend our members as robustly as possible to ensure that our members are not subject to unfair practices by the agencies they are accountable to. 

“The outcome of this decision will benefit not just our members, but the wider dental profession.”

 

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