Talking with the Toothcop

Everyone needs a compliance program tailored to the needs of their practice. Justin Withrow jumps in when a compliance program is absent and things go horribly wrong. Perhaps a client was employing an individual that's excluded from participation in the Federal Healthcare Program that should have been caught.

There is a multitude of things that could happen that could have been prevented by a compliance program. In this episode of Talking with the Toothcop, we dissect the importance of exclusion monitoring, the basics of the false claims act, self-disclosure protocol, and much more.

The importance of exclusion monitoring

Justin worked with a multi-location practice where the owner worked with walk-in and Medicaid clients frequently. He was doing criminal background checks and checking licenses with the dental board. But he didn't know an exclusion list existed with the Federal Healthcare Program that could exclude providers from working with the Medicaid program. Unfortunately, one of his providers knew they were excluded and didn't tell him. It resulted in a fraud investigation of his practice. He was looking at jail time for something that could easily have been avoided.

It feels like science fiction but it's the real deal. It's as simple as running your licensed staff members' names through a website. You need to know they're authorized to work with your patients so you can get reimbursed for services rendered. If you don't, they'll take that money back—and then some. Justin dissects the basics of the false claims act and the fines you could be looking at if you were caught in this situation. Don't miss it.

The submission of "unclean" claims

If you submit a claim for reimbursement by a provider who is excluded from a state Medicaid program, that claim is labeled as a false claim. Let's say a practice employs someone who they knew was excluded and billed services as rendered by a credentialed provider. If it was determined the service was rendered by an excluded provider, that triggers a false claim. Any service rendered by an excluded provider and submitted for reimbursement to Medicaid is a false claim.

If a provider has been excluded, that individual can't have contact with any patient insured with Medicare or Medicaid. If they work on that patient that claim cannot be reimbursed. That's why it is SO important to do exclusion checks. This applies to dental assistants, hygienists, and even administrative staff. Every member of your organization needs to be regularly run through exclusion databases.

Defining self-disclosure protocol

A compliance program helps you identify improper practices (something coded incorrectly, overpayment, etc.), catch them, and self-disclose or clarify that you made a mistake. You can let the governmental agency know a mistake was made and correct the mistake. Usually, you're given a certain time period—60 days—in which to self-disclose. The government knows mistakes happen. That's why this protocol exists.

If you're in the general ballpark of 60 days, it's usually fine. Even if you're outside of the 60-day window, doing nothing is the wrong approach. You will get in trouble down the road. It's always appropriate to rectify your mistakes when they're identified. Just work with a professional to do it appropriately.

What a compliance program must address

A compliance program must address the policies and procedures that an office uses to operate (i.e. OSHA, HIPAA, dental board regulations, state and federal regulations, etc.). You must properly and safely render care to patients while adhering to various laws of various agencies. It's an all-encompassing document that dictates how you do everything in your practice. It's who you are and how you operate. It has to be reflected in the day-to-day operation of your practice.

People always say, "We're too busy." That's NOT okay. It's an excuse. These things can't fall by the wayside. This has to be a staple of your business. There needs to be a compliance officer that is someone other than the dentist. They are your professional lifeguard. They stop the real cops from coming into play. If you're "Too busy" it's only a matter of time before you're audited or investigated.

Outline of This Episode

• [3:56] The importance of exclusion monitoring
• [6:30] The basics of the False Claims Act
• [11:56] Defining self-disclosure protocol
• [16:21] What a compliance program must address
• [24:12] Managing the merger and acquisition process
• [29:21] Possible reductions in fines and penalties
• [31:44] How to connect with Justin Withrow

OUR SPONSORS:

ProEdge Dental Water Labs: https://ProEdgeDental.com/Toothcop

Protective Dental: https://DentalCompliance.com/DrugKit

Resources & People Mentioned

• DENTAL COMPLIANCE RULES: NEW IN 2021 [PART II]
• DENTAL CHART AUDITING [WHY IT'S SO IMPORTANT]
• Connect with Justin Withrow
• Connect with Justin on LinkedIn

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

When you're in the midst of a busy day in your dental office, the details are the things that you typically let slide, right? But in the dental business, it's the details that keep you on track and it's the details that protect your office from huge fines and your Doctor from losing her licenses. This episode highlights some of the things I've seen recently that I think all dental office workers need to have top-of-mind. If you don't take these things seriously, you're going to have issues eventually.

Online training or in-person training? Which do you need?

Every dental office is going to be required to do Continuing Education from year to year. BLS, ACLS, and PALS are common certifications that need to be upgraded. Many times, compliance teams do their training through "approved" course providers through an online course. That's OK, but you can't assume that because it says "approved" or "certified" that it's truly that across the board. Your STATE may have additional requirements that the course provider is not aware of. For example, for some of the CE requirements, you can do the didactic part online and the testing part online. But you must have a hands-on, in-person evaluation of skills to finish up the CE credit. Don't get caught out of compliance because you didn't finish a course as was required. If you discover that's the case for you, simply fix the issue as soon as possible.

Office Inspections: Things I'm seeing that you should consider

As I do reviews at offices to help them get ready for State Board Inspections, I come across a variety of things that are of concern and should be addressed. One of the most common points where I'm finding errors recently is the Pre-Op Sedation/Anesthesia Checklist. State inspectors are fanatical about the form and want it to be used without exception. The title on your form must be exactly that: Pre-Op Sedation/Anesthesia Checklist. There is a lot of information on that form that is required to be ON the checklist. You will fail your sedation review if that is not the case. These are little things you need to make sure are properly in place to pass the inspection. You don't want to be embarrassed or look bad in front of the board. If you are not 150% sure on your checklist, send me a copy and I'll send you input on what you are missing (if anything).

Compliance around drugs is a huge issue I'm seeing of late

We all know there are compliance regulations in force surrounding the topic of expired drugs. But lately, I've come across offices that have terrible problems in this area. Many offices have their checklists but they are not accurate or up to date. In one situation I encountered, the NEWEST expiration date on drugs in their facility was dated 2016. That's so problematic! You MUST be up to date by removing expired drugs from the premises, and by keeping accurate records. You're playing a risky game if you're not taking compliance issues like this seriously. Don't just check the boxes on the forms, pay close attention to the reality of you drug inventory. Protect yourself and your patients. It doesn't matter until it matters, and then it matters big time!

Why office inspections are powerfully helpful for your dental practice

The beauty of what I do and how I do it is that I'm able to do office inspections as a neutral 3rd party. That means I'm able to be entirely objective because I am not tied to the outcome in any way. I'm not so close that I can't see the issues. This helps me identify what needs to be fixed, help the staff fix the issues, and move on. It really is that simple. There's no need for panic or concern because you find something of concern. Just call and I'll come out and assess everything, give you my recommendations, and point you in the right direction to fix any compliance issues I find.

Quotes for this episode:

"If you continue to think the way you've alway thought, you'll continue to get what you've always got." - Kevin Trudeau

"Do all the good you can, by all the means you can, in all the ways you can, in all the places you can, at all the times you can, to all the people you can, as long as you can." - John Wesley

Outline of This Episode

• [3:58] Continuing Education requirements - changes, updates, clarifications
• [10:35] Office reviews and concerns that I'm seeing as I do these reviews
• [18:05] Best-practices for Dental office reviews (the article is linked below)
• [25:15] The quotes we've found helpful this past week

Resources & People Mentioned

OUR SPONSORS:

ProEdge Dental Water Labs: https://ProEdgeDental.com/Toothcop

Protective Dental: https://DentalCompliance.com/DrugKit

• Get the physical newsletter: The Dental Legal Update (Jeanine's website)
• Dental IQ: Survivor: Dental office audit edition

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

During the 4th Quarter of 2021 we saw a lot of enforcement activity, from the agencies that are announcing their fraud enforcement efforts to insurance companies that are initiating audits, etc. So whatever you're involved with (Medicare, Medicaid, Indian Health Services, etc.), be sure you have an audit process in place that includes good records on the steps you've taken. You need to be able to prove your compliance should an audit or investigation comes your way.

Narcotics charges against a Michigan Dentist, and lesson for all of us

A Michigan Dentist was busted recently on narcotics charges, and it's easy to sit at a distance and pass judgement. But regardless of the facts in this case, there are other things that happen along this line that are more common. For example: sometimes only one Dentist has a DEA license but the others in the practice may write scripts using the other Doc's DEA number. That's a dangerous habit to get into. This news story demonstrates that the powers that be are not looking the other way. Don't share your credentials and don't allow other providers to use your credentials. Sharing is not caring in this situation.

Are you considering the purchase of a dental practice?

If you are considering buying a dental practice and the practice has been guilty of compliance issues, you will become liable for those issues the moment you buy the practice. So you need some kind of due diligence process that will assess the practice before you buy to ensure you're not buying a piece of junk that you can't get into compliance. But the good news is that not all things that look terrible are terrible. Duane has seen many situations where a practice was able to be easily fixed, then sold (like house flipping) for a profit. If you're looking for support in the purchase of a dental practice, reach out!

Outline of This Episode

• [3:06] Duane's interest and belief in goals (and another puppy)
• [7:13] Regulatory action is taking place, so be sure your audit process is up to date
• [8:44] A Michigan dentist is guilty on narcotics charges brought by the DEA
• [14:38] The Self-Disclosure Protocols have been renamed
• [17:27] The DOJ reintroduces corporate compliance monitors
• [26:31] NEW SEGMENT: Inspirational Quotes

Resources & People Mentioned

• Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you!
• The Pro Edge Water team - www.ProEdgeDental.com/Toothcop (affiliate)
• Michigan Dentist busted by the DEA
• Self Disclosure Protocols renamed
• CIA's are back!
• The Justice Department's criminal fraud page

"We don't rise to the level of our expectations, we fall to the level of our training."

"Don't practice until you get it right, practice until you can't get it wrong."

"Most people never run far enough on their first wind to find out they have a second wind."

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

I started the Talking with the Toothcop podcast in December 2017. Andrea has been with me since early 2019. We love doing this podcast together. Sadly, it's time for us to hit the pause button. We will be back—I promise! But we have a lot on our plates right now and it makes sense to pull back temporarily. If this podcast has been rewarding and educational for you professionally, take some time and go back to listen to our episode archive!

Outline of This Episode

• [0:22] What's happening in our lives!
• [4:18] Check out ProEdge Dental
• [7:01] Sharing some bittersweet news
• [9:07] Learn more about protectIt dental

Past podcast episodes to check out!

Check out some of our most popular and episodes packed with need-to-know information:

• Dental Unit Waterlines: the Good, the Bad, and the UGLY (with Mike Rust + Kellie Thimmes
• The 7 Elements of Dental Compliance Programs
• How a Compliance Program can Save Your Bacon
• Sedation Inspections + EPCS + Continuing Education
• The Importance of Sterilization Processes - Stephen Kovach

We're always here to answer questions, so don't be afraid to reach out. Until we return, subscribe to our email list!

Resources & People Mentioned

• Check out ProEdge Dental at https://proedgedental.com/toothcop!
• Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you!

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

I work with dental offices and do a lot of dental inspections/consults. I help people identify what they need to do differently. We talk through OSHA, HIPAA, infection control, radiology, medications, state board compliance, etc. But I get really excited about infection control and sterilization. That's my stage—my moment to shine. In this episode of Talking with the Toothcop, we're going to talk about instrument processing and cleaning procedures. Find out what you could be doing wrong and what to do instead!

Outline of This Episode

• [0:49] Time to redo the 75 Hard Challenge!
• [6:00] Check out ProEdge Dental at https://proedgedental.com/toothcop!
• [7:16] What a sterilization room should look like
• [10:46] Don't neglect monitoring your ultrasonic
• [14:37] Follow manufacturers instructions for use
• [16:45] Other things to note when using your ultrasonic
• [20:20] Learn more about protectIt dental at https://dentalcompliance.com/drugkit
• [21:46] Check out the 2021 Dental Compliance Bootcamp!

What a sterilization room should look like

I've seen thousands of sterilizations rooms. Some are great, some are poorly designed, and some just don't shock me anymore. What should it look like? It needs to be physically segregated into different areas for instrument receiving and cleaning, decontamination, preparation and packaging, sterilization, and storage.

There needs to be a "cleaned" area and a dirty area. I can't tell you how often I see cross-contamination issues. When you bring the instruments into sterilization, the rest of the processes need to move in one direction. If you move in the opposite direction, you're contaminating what's supposed to be sterile.

Don't neglect monitoring your ultrasonic

A sterilization area contains two major processes: instrument cleaning and sterilization. If you don't do one part right, it impacts the entire process. There are monitors in place for the sterilizer, color-changing indicators on instrument peel-pouches, and indicator tape on instrument cassettes. They give us visual confirmation of whether or not the sterilization process worked.

People often monitor the sterilization indicators but neglect the cleaning side of the process. You can't just assume the instrument washer or ultrasonic is working effectively. Just because it sounds like it's working properly doesn't mean it is. You need a qualitative test—like a foil test—to make sure that it's working properly. It needs to be done frequently. When those machines fail, they don't sound any different. It is not obvious.

I don't love the foil test. What do I prefer instead? An ultrasonic cleaning monitor. It can be ordered through your dental suppliers. Get and use that weekly. Record in your records that it passes inspection. It gives you information on several data points: cavitation, enzyme concentration, and more.

Follow manufacturers instructions for use (IFU)

Are you using the correct concentration of enzymes in the ultrasonic? More than half of dental offices aren't. Whatever product that you use for ultrasonic enzymes, make sure you follow the manufacturer's instructions for use. People frequently use the wrong concentration, which is why I'm partial to tablets. It's easier to calculate.

Secondly, people don't understand the water capacity of the ultrasonic. The box says "one tablet per gallon" so they drop one tablet in, not realizing they have a three-gallon unit. One tablet won't cut it—you're off by a lot. I was in an office last week that had a three-gallon ultrasonic and they were putting in one tablet. According to the IFU, they were supposed to be using two tablets per gallon. They should have been using six tablets total!

What's an easy way to track this? Buy a label maker and print the name of the product and the number of tablets/ounces required each time you fill an ultrasonic.

Other things to note when using your ultrasonic

What else do you need to focus on?

• Run the ultrasonic with the cover on. When the cover is not in place, you're spewing aerosols of biohazards into the air. If you don't have a cover, get a replacement.

• Anything that has moveable parts or hinges must be in the open position before it goes in the ultrasonic. If you're not doing this, bioburden accumulates in the jaw or hinge. Those parts must be exposed to be adequately cleaned and sterilized.
• Cleaning time is important and it varies per dental instrument. Review the IFUs for each individual piece you have as well as peel-pouches and instrument cassettes.

If you run the instruments and find when you're rinsing them that they're still dirty, what do you do? Run the cycle again. Fight the urge to manually scrub instruments. You will never do as good of a job as the instrument washer/ultrasonic.

Tune in next week for part II—the sterilization process!

Resources & People Mentioned

• Check out the 75 Hard Program
• Ultrasonic Cleaning Monitor
• Check out the 2021 Dental Compliance Bootcamp!
• Check out ProEdge Dental at https://proedgedental.com/toothcop!
• Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you!

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

It's September! And it's officially Dental Infection Control Awareness Month! We get you're probably sick and tired of hearing about COVID and infection control. So guess what? Andrea and I will cover infection control without mentioning COVID, other than right now...We'll cover getting a point-person in place and written policies and procedures. Check it out!

Outline of This Episode

• [0:20] Dental Infection Control Awareness Month!
• [1:20] Check out ProEdge Dental at https://proedgedental.com/toothcop!
• [3:02] Every office needs a point-person
• [6:17] Make sure you have written infection-control protocols
• [10:31] Learn more about protectIt dental at https://dentalcompliance.com/drugkit

Every office needs a point-person

This is an opportunity to use the time we have in Slowtember to review infection control protocols. Every office needs to have an infection prevention coordinator—or OSHA safety coordinator—to oversee all things related to employee safety and infection control. If more than one person is in charge, no one is in charge. Andrea points out that you don't want to run into a situation where you're saying, "Oh, I thought you were taking care of that."

Secondly, you want to make sure if that person leaves their role is reassigned to someone else. If you don't know who it is, you probably don't have someone in place. I promise you, there will be someone in your practice who wants to do the role. But if no one steps up, so be it. Someone has to lead the pack and you get to choose who that someone is. But make sure you give them the paid time to get it done.

Make sure you have written infection-control protocols

You need to have written policies and procedures that establish how you do things. According to the CDC, you need written procedures specific to the dental setting. This includes things like:

• Procedures for containing respiratory secretions
• Rules for sick employees
• Infection control education
• Policies for immunizations and vaccinations (Hepatitis B, Chicken Pox, MMR, Tetanus, Diphtheria/Pertussis)
• Safe injection practices for sharps/needles
• Rules for cleaning and sterilizing contaminated dental instruments
• Having instructions for use for medical devices and instruments (handpiece, sterilizers, x-ray machines, etc.)
• Cleaning and disinfection protocols for surfaces
• Cleanups of chemical spills or bodily fluids
• Testing dental unit waterlines + water treatment
• Protocols for the correct use of sterile water
• Rules for how to manage boil water advisories
• A tuberculosis exposure control plan (review the statistics for your country and state)

Many dental offices that have a written set of protocols have never read them. That means practices are simply assuming their staff has been trained on these things. Not good. The dentist is expected to have the most knowledge and experience with infection control. Sadly, they're often the least knowledgeable and experienced. Don't let that be you! You also want to have a detailed conversation with your staff about these protocols. Does your staff know them? You're only as strong as your weakest link.

Mark your calendar for Dental Compliance Bootcamp 2021! Bootcamp is all things compliance and risk-management related. It's available to non-clients (even better, It's FREE for current clients).

Resources & People Mentioned

• Check out ProEdge Dental at https://proedgedental.com/toothcop!
• Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you!
• Mark your calendar for Dental Compliance Bootcamp 2021

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Did you know that September is National Preparedness Month? So in this episode of Talking with the Toothcop, we share some quick tips your practice can follow to be prepared—for whatever may come. We also share a few ways you can take advantage of "Slowtember" and prep for the year to come.

Outline of This Episode

• [0:22] Quick tips for emergency preparedness
• [6:00] Take advantage of Slowtember
• [11:57] Check out Compliance Bootcamp
• [12:45] Shoutout to some podcast listeners!

Quick tips for emergency preparedness

What are some easy things you can do to prepare your practice for emergencies?

• Check that emergency lighting (exit signs) are working properly if there's a power outage.
• Check your fire extinguishers and make sure they aren't overdue for inspection. The fire department can do—and will sometimes just walk in—fire extinguisher checks for you.
• Check your smoke detectors and change the batteries regularly.

• Make sure that you perform an annual emergency drill. Have your staff put their John Hancock on a sign-in sheet and keep documentation proving you completed training. If it ain't written, it didn't happen.

• Get out your medical emergency plan and review it with your staff. Make sure that you walk through every part of the process (except calling 911).

Take advantage of Slowtember

September is a slow month for many dental practices, so make sure—if you haven't already—to get your compliance training knocked out. Cover bloodborne pathogens, HIPAA, cybersecurity, etc. If you participate with Medicaid/Medicare, you'll also need to do your Fraud, Waste, and Abuse training.

Take a few minutes to review everyone's credentials and make sure they're up-to-date. You should check CPR certifications, DEA registrations, sedation permits, even your driver's license and vehicle registration. Check anything that has an expiration date on it—both personally and professionally.

What else can you do? Mark your calendar for Dental Compliance Bootcamp 2021! Bootcamp is all things compliance and risk-management related. It's available to non-clients (even better, It's FREE for current clients).

Resources & People Mentioned

• Check out ProEdge Dental at https://proedgedental.com/toothcop!
• Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you!
• Mark your calendar for Dental Compliance Bootcamp 2021

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

In this episode of Talking with the Toothcop, you get a glimpse into the "behind the scenes" of what recording an episode really looks like. From food pranks to our favorite Starbucks orders—every tangent that we usually edit out is on full display. Don't miss a fun and quirky episode that also includes some important news about our Dental Compliance Bootcamp! Listening may even get you some FREE coffee!

Outline of This Episode

• [0:21] Food pranks: Starbucks + Subway
• [6:10] Check out ProEdge Dental at https://proedgedental.com/toothcop!
• [12:12] Dental Compliance Bootcamp 2021
• [20:00] Record-keeping + Compliance Programs + Cybersecurity
• [27:48] Learn more about protectIt dental at https://dentalcompliance.com/drugkit

Learn about Dental Compliance Bootcamp 2021

Bootcamp is coming up, November 19th-20th in Hurst, TX (in the DFW area) at the Hurst conference center. The Hilton Garden Inn is attached to the conference center.

• We are going to have some hands-on medical emergency training. After attending, dentists will be able to facilitate training for their staff. Secondly, bring your team and run through some scenarios together.
• Justin Bonner, DDS Board Certified in Oral and Maxillofacial Surgery & Garrett Starling, MD Board Certified Anesthesiologist will be there! (the course instructors for our pain management course)
• You'll get some courses on insurance with Tonya Burns (Pediatric Consultant).
• Laura Diamond—a healthcare attorney—will be returning this year. She'll be presenting in our risk-management and record-keeping course.

The goal is to provide you hands-on clinical training that you can immediately put into practice.

This years theme: Record-keeping + Compliance Programs

Most of our presentations will center around:

• We will go in-depth on the nuts and bolts of a corporate compliance program for people who participate in Medicare/Medicaid. We will also complete a mock compliance committee meeting. You'll learn what you need to talk about and cover in these meetings.
• Record auditing is a major element of compliance. We'll cover what you need to audit/monitor, what it looks like, what records to create, and how to solve problems when you run into them.

If you have any compliance responsibilities, come and immerse yourself in the experience. It's not your typical conference. It is hands-on and immersive and you will get to experience everything with us. This is an opportunity to learn great things to apply to your organization. It's also a chance for you to interact with our clients to decide if we're a great fit for you.

What's your favorite drink from Starbucks? Let me know at toothcop(at)dentalcompliance.com and I'll put you in a raffle for a gift card!

Resources & People Mentioned

• Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you!
• Mark your calendar for Dental Compliance Bootcamp 2021
• Hurst Conference Center
• Hilton Garden Inn Hurst

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Did you know there are specific rules from the Office of the Inspector General (OIG) regarding giving things of value (i.e. gifts) to solicit potential customers? In this episode of Talking with the Toothcop, Andrea and I talk about some of the specific rules on gifts and kickbacks. This is stuff that you need to be aware of so you don't get hit with penalties and fines for breaking the law.

Outline of This Episode

• [3:34] The OIG Backpack Rule
• [11:26] Texas Administrative Code Rule 108.58
• [15:25] The anti-kickback statute (42 U.S.C. 1320a-7b)
• [20:34] Section 259.008 Dental Practice Act
• [23:03] "But everyone is doing it"
• [28:08] Dental Compliance Bootcamp 2021

The OIG "Backpack" Rule

The OIG released a special bulletin entitled "Offering Gifts and Other Inducements to Beneficiaries." This advisory from the OIG clarifies how the state interprets and applies the rules and statutes to giving things of value to Medicaid benefit recipients.

While they understand the competitive market and desire of dental practices to differentiate themselves in the mind of potential patients, they must uphold the integrity and fairness of the Texas Medicaid program. Giving gifts may raise concerns among the community and other providers.

The OIG reinforces Texas Administrative Code §371.1669, which prohibits a person "From transferring or offering any remuneration which the person knows or should know is likely to influence the beneficiary's selection of a provider, practitioner or supplier of Medicaid payable items or services."

The state of Texas has announced that they will enforce more stringent rules than the HHS OIG, including:

• Providers are prohibited from offering items or services to influence health care decisions. The OIG presumes that any items that do not exceed $10 per patient were not provided to influence their decisions.
• Likewise, anything offered to a patient must be directly related to dentistry (i.e. a toothbrush, toothpaste, floss, etc.). You are NOT allowed to give patients backpacks and school supplies, even if your intentions are good. We get that it's back-to-school time and people like to give out back-to-school supplies. Dental providers cannot do that.
• You may never offer patients cash or gift cards.

Is it different for non-Medicaid providers? Non-Medicaid providers still have to adhere to the Texas Occupations Code Section 102: Solicitation of Patients, which includes rules about not giving gifts to patients (though it doesn't explicitly call out backpacks). Can non-Medicaid providers give gifts or do giveaways for current patients? Listen to learn more about Texas Administrative Code Rule 108.58

The anti-kickback rule (42 U.S.C. 1320a-7b)

The Anti-Kickback Statute is a criminal law that prohibits the knowing and willful payment to reward patient referrals or the generation of business involving any item or service payable by the Federal healthcare programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).

This includes things like rent, hotel stays, meals, excessive compensation, paying referrals, etc. Physicians or dentists who accept or pay kickbacks will be penalized up to $50,000 per kickback plus three times the amount of the remuneration. Dentists make attractive targets for kickback schemes because you are a source of referrals.

Kickbacks in healthcare can lead to overutilization, increased program costs, corruption of medical decision-making, patient steering, and unfair competition. I hear of offices that offer free or discounted dental care for parents if they bring their children on Medicaid to the practice—which is clearly a violation of Federal law. Taking a kickback can never be justified, even if the service rendered was medically necessary.

More of this is coerced in Texas Occupations Code Sec. 259.008 Unprofessional Conduct.

When people say "But everyone is doing it"

Some dentists have pointed out to me that there is an unfair advantage because dentists in their community do these things. The temptation to get involved in a scheme like this is high because "everyone is already doing it." Firstly, don't do something that everyone else is doing. That's not how you grow your business (especially with something illegal).

Instead, find out what's legal in your state (and federally) and then run tests to see what works. It can be as simple as focusing on giving your patients the greatest experience possible. You can make it a memorable and pleasurable experience. How can you take customer experience up a notch?

Lastly, if people in your community are doing illegal things, perhaps they aren't aware. If you have the gumption, you can talk to them about it.

We cover a lot in this episode. Listen to the whole thing for all the nitty-gritty details!

Resources & People Mentioned

• Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you!
• Check out ProEdge Dental at https://proedgedental.com/toothcop!
• Offering Gifts and other Inducements to Beneficiaries
• Texas Occupations Code Section 102: Solicitation of Patients
• Texas Administrative Code Rule 108.58
• 42 U.S.C. 1320a-7b - Criminal penalties for acts involving Federal health care programs
• Texas Occupations Code Sec. 259.008 Unprofessional Conduct
• Mark your calendar for Dental Compliance Bootcamp 2021

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Are PMP inquiries required for sedation meds that are dispensed in the office? A listener read through the rules in January 2020 and spoke with a sedation officer and was advised that they did not need to do the PMP check if they were dispensing in the office. But the way the rule is worded makes it seem as though you do need to. So in this episode of Talking with the Toothcop, Andrea and I will cover Chapter 111 and spell out the PMP rule in detail. Hopefully, this will clear up any confusion you may have!

Outline of This Episode

• [3:43] Rule 111.1: Additional Continuing Education Required
• [6:24] Rule 111.2: Self-query of Prescription Monitoring Program
• [7:43] Rule 111:3: Prescription Monitoring by the Dentist
• [10:51] Breaking down the PMP inquiry rule
• [12:54] Rule 111.4: Prescription Monitoring by the Board
• [14:12] Rule 111:5: Electronic Prescribing Waivers
• [16:51] Subscribe to our email list to stay up-to-date!

Rule 111.1 Subsection B: Additional Continuing Education Required

According to Rule 111.1 Subsection B, effective September 1st, 2020 every dentist that prescribes controlled substances must complete two hours of continuing education "...related to approved procedures of prescribing and monitoring controlled substances." This can be taken annually to count toward continuing education.

Dentists have found this confusing because many have already taken the course. However, the requirement reset September 1st, 2020. So anyone who completed the two hours of continuing education on controlled substances before that date must retake it before September 1st, 2021. I know several thousand dentists have not yet taken this course. We offer this course on our site—that you can complete at your own pace—so check it out.

Rule 111.2: Self-query of Prescription Monitoring Program

Rule 111.2 became effective Dec. 25th of 2016:

"Each dentist who is permitted by the Drug Enforcement Agency to prescribe controlled substances shall annually conduct a minimum of one self-query regarding the issuance of controlled substances through the Prescription Monitoring Program of the Texas State Board of Pharmacy."

Many dentists don't even have a login for the PMP. You need to do this. The state board of pharmacies can report you and you'll have to answer for your failure to comply. You will face disciplinary action, which starts with paying a fine and lead to jurisprudence assessment.

Rule 111:3: Prescription Monitoring by the Dentist

Rule 111:3 became effective March 1st, 2020, and says:

"(a) Prior to prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol, a dentist shall access the patient's prescription drug history report through the Texas State Board of Pharmacy's Prescription Monitoring Program (PMP) Clearinghouse. Failure to do so is grounds for disciplinary action."

The rule goes on to say that an employee of the dentist can do the PMP check when directed by said dentist. The only exceptions? The PMP inquiry does not have to be completed if the patient is diagnosed with cancer or receiving hospice care and it's noted in their record.

If the dentist cannot do the inquiry due to circumstances outside their control—but has attempted—is not considered to have violated the rule. What circumstances might be outside of the dentist's control? This would include something like the PMP website being down, your internet is down, etc.

You need to get a process in place, look at the drugs you prescribe, and make sure that you check the patient's drug history through the PMP before you prescribe opioids, benzodiazepines, barbiturates, or carisoprodol.

Administering versus prescribing or dispensing: What Gives?

The PMPinquiry rule doesn't apply to administering these drugs but prescribing or dispensing. Dispensing is giving it to the patient to take it later. Prescribing usually entails the patient picking up the medication from the pharmacy. In both cases, the patient has possession of the controlled substances with the opportunity to take them.

A PMP check is not required prior to administering to a patient in your chair immediately. Why? Because you are controlling how it's administered and how much is administered. So if you're doing in-office sedation and giving it to the patient immediately from your office supply, you don't need to do the PMP Check. If you prescribe the drug for the patient to pick up and you to administer, then you do need to complete the inquiry before doing so.

We cover a few other pertinent rules in this episode so be sure to listen all the way through! Let us know if you have any questions at toothcop(at)dentalcompliance.com.

Resources & People Mentioned

• Rule 111.1 Subsection B
• PRESCRIBING & MONITORING PRACTICES
• Texas Prescription Monitoring Program
• E-Prescribing Waiver
• Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you!
• Check out ProEdge Dental at https://proedgedental.com/toothcop!

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube