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In Praise of Periodontists, Dentists & the Anti-Kickback Statute

One hears about cases involving fraud by medical
professions all the time. Sometimes there are even cases involving dental professionals under the False Claims Act.  In fact, back in October the DOJ settled a case against a group of dental clinics for $5 million.  The DOJ Press release I saw did not mention any whistleblower involvement but if someone was responsible, I hope they will contact me and I’ll be glad to add their names to the record.

It’s a real shame when any medical professional violates The False Claims Act or the Anti-Kickback Statute or the Stark Law because it goes to our relationship with our doctors.

I was reminded of this today in a rather personal way.  For the past several years I have had a Periodontist and a Dentist fighting against the misspent youth/middle age of my teeth.  The doctors have worked very hard to fix all the problems that accrue when somebody either is born with bad teeth or does not take care of them or (sadly, in my case) both.

This morning I had to go to the Periodontist for a procedure I was expecting. Upon review of the X-Rays he and the Dentist recommended additional work, too. I agreed, of course. I signed the consent forms and had the work done.

The most important factor in this situation (besides the doctor’s considerable skill— you really don’t want somebody performing oral surgery unless they absolutely know what they are doing) is trust. I trust these doctors.  In some ways that’s a little easier now for me than for many people or for many other kinds of medical work.

These are the same professionals I’ve been seeing for several years. They have done right by me over the years.  The results have been great as well.  So this is a happy story.  It may be harder in today’s medical world to develop that type of trust with a doctor.

The point is that the real fraud cases which merit a False Claims Act case also undermine the trust we all want to be able to place in medical professionals. We all want to believe they are making decisions on the basis of what is right for us not on what is right for business

Most big False Claims Cases do not get directed at Doctors. Usually it’s medical device manufacturers and pharmaceutical companies that are the big targets and sometimes large hospitals/service providers with billing departments get hit as well. However, the financial pressure of business and large institutions also mounts on individual medical professionals, of course.  The same business costs are directed at the physician and dentist, and as small business people who must pay the rent and market their services and make a living, we are always putting them in an astonishingly bad position.

We do not have many checks on this system. The Anti-Kickback Statute and the Stark Laws and the False Claims Act do work, but they are very powerful tools and are really only appropriate for the worst kinds of offenses. They are for the kinds of violations that undermine the trust between patient and doctor. That’s something that is absolutely worth preserving even if we have a medical system that seems to work against it on a daily basis.  I can see why people find this situation sad. We would all rather be able to trust the medical world and not have to resort to litigation. I’m sure there is a better system out there somewhere.

Until then, we will need to go after the worst offenders who make it more and more difficult for patients to be able to trust their doctors.