ADA Files Class Action Lawsuit Against Delta Dental For Antitrust Violations

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On November 26, 2019, the American Dental Association (ADA) and two individual dentists filed a class-action lawsuit against the Delta Dental Plans Association, its affiliated national entities, and 39 independent Delta Dental companies. The suit alleges the provider network engaged in anticompetitive conduct and violated federal antitrust laws.

The ADA filed its lawsuit in the U.S. District Court for the Northern District of Illinois.

Details of the Suit.

The complaint alleges Delta Dental allocated territories of operation and divided the national market to restrict competition, reduce reimbursement rates, and force unfavorable coverage to dentists. “Its harm is reflected in the suppression of compensation below levels that would prevail in a competitive marketplace to dentists who are members of the Delta Dental provider network,” the suit alleges.

Hurting Both Dentists and […]

By |2024-03-14T10:00:07-04:00December 17, 2019|Categories: Dental Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , |Comments Off on ADA Files Class Action Lawsuit Against Delta Dental For Antitrust Violations
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Dentists: Challenge Overpayment Demands from Medicare, Medicaid Audits!

Attorney Indest headshotDuring our years of experience, we have gotten many calls from dentists who have been placed on prepayment review after failing to challenge the results of Medicare and Medicaid audits. Once placed on prepayment review, the payments are held up for many months. Some providers are even forced out of business as a result.

Failing to challenge, follow-up on, and appeal any adverse results of Medicare and Medicaid audits can be very detrimental. An error rate above 15% will usually result in the provider being placed on prepayment review.


What Happens During Prepayment Review.

While on prepayment review, the dentist or provider will be required to submit documentation for medical records by mail to support each claim submitted. Additionally, they must have those claims and supporting documentation audited, before any […]

By |2024-03-14T10:00:09-04:00November 6, 2019|Categories: Dental Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Dentists: Challenge Overpayment Demands from Medicare, Medicaid Audits!
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You Could Face Steep Repercussions From License Discipline or Resignation After Notice of Investigation

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Do you have a dental, medical, pharmacy or nursing license in several different states? Do you have a license in more than one health care profession? Have you been notified that an investigation has been opened against you? Are you thinking about resigning your professional license or voluntarily relinquishing such a license? Then you must be aware of the following information.

First, you should never voluntarily relinquish or resign your license after you know that an investigation has been opened or that disciplinary action has been taken against you. Such resignation is considered to be a “disciplinary relinquishment” and is treated the same as if your license had been revoked on disciplinary grounds.

Second, this will be reported out to other states, agencies, to the National […]

By |2024-03-14T10:00:13-04:00May 23, 2019|Categories: Dental Law|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on You Could Face Steep Repercussions From License Discipline or Resignation After Notice of Investigation
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DOH: Thousands of Florida Dentists Skipped Required Opioid Training

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 5, 2019, state officials announced that about one in four Florida health care providers failed to take a required two-hour continuing education (CE) course on prescribing controlled substances.  The deadline for the mandated course was January 31, 2019. The Florida Department of Health (DOH) is now preparing to send non-compliance letters advising the providers that they have 15 days to take the mandated course or face disciplinary action, said DOH agency spokesman Brad Dalton.

“If the department does not receive a response within 15 days from receipt of the notice, a formal complaint will be initiated,” he said.


New Standards for Prescribing Controlled Substances.

A law in 2018 required all […]

By |2024-03-14T10:00:15-04:00May 10, 2019|Categories: Dental Law Blog|Comments Off on DOH: Thousands of Florida Dentists Skipped Required Opioid Training
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Dental Clinic Owners Found Guilty of $1 Million Medicaid, Tax Scheme

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 21, 2019, a federal jury found the owners of several dental clinics in Missouri guilty of a $1 million scheme to defraud the government. The owners of All About Smiles LLC, were convicted of submitting false claims to Medicaid for dentures and other services and payroll tax fraud, according to prosecutors.

Submitting False Claims.

Prosecutors alleged that the couple that owned the practice ran several schemes through the dental clinics from 2010 to 2015, including conspiring to defraud Medicaid. A main part of the scheme was to provide dentures and other services to adults who didn’t qualify for Medicaid. They would then bill the Medicaid program anyway, receiving more than $720,000, according to […]

By |2024-03-14T10:00:16-04:00April 18, 2019|Categories: Centers for Medicare and Medicaid Services, Dental Law Blog, Dentist Defense attorney, Health Care Fraud, Health care Law, Medicaid fraud, Medicaid Fraud|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Dental Clinic Owners Found Guilty of $1 Million Medicaid, Tax Scheme
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DeSantis Rescinds Large Number of Appointments Made by Former Governor, One from Board of Dentistry

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 22, 2019, Florida’s new Governor, Rick DeSantis retracted 169 appointments that the former governor made before leaving office. One of these was to the Florida Board of Dentistry. This is not the first time he has called back last-minute decisions made by his predecessor. In January 2019, he retracted 46 of Scott’s “lame duck appointments.”

The new governor has now pulled a total of 215 of Scott’s prior appointments to various boards and committees.

Here’s a List of the Appointments Made by Scott That Governor DeSantis Pulled for the Professional Boards Under the Department of Health (DOH):

Angela Sissine, Board of Dentistry

Steve Moreau, Board of Acupuncture

Steven Falcone, Board of Medicine

Andre Perez, Board of Medicine

Merle Preston […]

By |2024-03-14T10:00:16-04:00March 25, 2019|Categories: Dental Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on DeSantis Rescinds Large Number of Appointments Made by Former Governor, One from Board of Dentistry
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Florida Woman Accused of Operating Illegal Dental Practice Out of Her Garage

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 16, 2018, a Florida woman was accused of practicing as an unlicensed dentist, operating out of her home garage. After receiving an anonymous tip, Palm Beach County Sheriff’s deputies arrested Alexandra Gallego after a month-long investigation into the illegal practice.

She is facing charges of Practicing Dentistry without a License, and Unlawful Use and Control of Dental Equipment.

Practicing Without a License.

In addition to running an illegal practice, Gallego is accused of offering discounted rates to patients who paid in cash, couldn’t afford insurance or did not have the proper documents to legally be in the United States. When investigators searched the home, they found a makeshift dental office, including X-rays, medications and payment receipts located in the garage.

She told authorities she would see about 160 […]

By |2024-03-14T10:00:20-04:00November 28, 2018|Categories: Dental Law Blog, Uncategorized|Tags: , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Woman Accused of Operating Illegal Dental Practice Out of Her Garage
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Dentists Smiling as $80 Million Settlement Reached in Dental Supply Price-Fixing Class Action Suit

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On August 30, 2018, after two years of litigation, a group of dentists tentatively reached an $80 million settlement in a proposed class action accusing the country’s biggest dental supply companies of colluding to fix prices. The three dominant distributors, Henry Schein Inc., Patterson Cos. Inc. and Benco Dental Supply Co. Inc., allegedly artificially inflated prices on crowns, numbing agents, X-ray accessories and other products.

Artificially Inflating Prices.

In 2016, the three distributors were accused of artificially inflating prices on various dental supplies and equipment. Products at issue included supplies such as adhesives, implants, tooth brushes, pins and posts all the way to equipment such as imaging devices and dental chairs. Although there are hundreds of distributors and manufacturers of dental supplies and equipment, the defendants controlled approximately […]

By |2024-03-14T10:00:22-04:00October 1, 2018|Categories: Board of Dentistry, Dental Law, Dental Law Blog, Dentist Defense attorney, Dentistry Law, Dentists|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Dentists Smiling as $80 Million Settlement Reached in Dental Supply Price-Fixing Class Action Suit
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NYC Doctor Gets Prison Term for Posing as Clinic Owner in $30 Million Fraud Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On August 22, 2018, a doctor received a sentence of one year and a day in prison from a New York federal court for his part in a $30 million scheme to defraud Medicare and the state Medicaid program. The doctor admitted to posing as the owner of a medical clinic and falsely claiming to have seen hundreds of patients. He pled guilty on January 11, 2018, to health care fraud and conspiracy to commit health care fraud, mail fraud and wire fraud, the U.S. Attorney’s Office said.

Lies and Cover-ups.

The New York City doctor accepted responsibility for falsely posing as the owner of two medical clinics that were actually owned by a corrupt businessman, according to the U.S. Attorney’s Office for the Southern District of New […]

By |2024-03-14T10:00:22-04:00September 7, 2018|Categories: Board of Dentistry, Dental Law, Dental Law Blog, Dentist Defense attorney, Dentistry Law, Dentists|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on NYC Doctor Gets Prison Term for Posing as Clinic Owner in $30 Million Fraud Scheme
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CMS Memorandum for Texting Patient Information Among Healthcare Providers

George F. Indest III headshot

June 21, 2018

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Centers for Medicare & Medicaid Services (CMS) released a Memorandum in an effort to clarify their stance and guidelines on texting between healthcare providers and staff.

Texting Patient Orders is Not Permitted.

CMS does not permit  health care providers to text patient orders to a care team member on any platform. Therefore, texting patient orders from a health care provider is not in compliance with the Conditions of Participation (CoPs) or Conditions for Coverage (CfCs).

Texting Patient Information on Secure Platforms.

Patient information that is sent via text messages  is permissible if accomplished through a secure platform only. However, Computerized Provider Order Entry (CPOE) is the preferred method of order entry. CMS holds to the long-standing practice that […]

By |2024-03-14T10:00:25-04:00June 21, 2018|Categories: Dental Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , |Comments Off on CMS Memorandum for Texting Patient Information Among Healthcare Providers
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