Townies question of the month

My office policy about staff dental work has always been that preventive, basic restorative, endo, etc. are at no charge. Major restorative (crowns, bridges, veneers, etc.) and bleaching at lab cost. Now here's the problem. One of my employees has dental insurance through her husband's work. She says that since the other staff members get their work for free or at lab fee, she should get the same, and the insurance money should go to her. I told her basically, "Bull, you aren't getting paid for the work I do. I think that whatever the insurance pays should go to the practice." She wants to compromise and split the money. I don't think this is fair to the practice (me) since (1) I'm eating the potential production from an appointment that could go to a full-fee patient (2) She's getting paid her normal salary while her butt is resting in my chair rather than producing in the hygiene department, and (3) it's costing us materials, staff support, etc. during this appointment time. What does anyone else think? What do you do about employees with insurance in your offices? And how about their spouses? I give them a 50% discount, but what about their insurance?

Who should that go to?
Boris, Official Townie

It should unquestionably, go to you. No way should it go to the employee. They should be happy with what they get and not be looking over their shoulder at what the next person is getting. This, by the way, is one reason I have no written office policy. I know it goes against the conventional wisdom. Once you put things in writing people tend to look at them too closely and you end up with the nitpickers who feel justified in their anger. Regardless of how generous a person you are.
mike_espisito_dds, Official Townie

Just tell her it's illegal and would be insurance fraud. Or if she really wants the same treatment as everyone else, offer not to submit for reimbursement…then it's just like the others.
david_f, Official Townie

After 90 days of continuous employment the staff and their immediate family (spouse, kids) get free dental care (they pay lab fees). If they/spouse have dental insurance they are required to use it and the practice gets it. Period. Now if they have a lab fee and insurance then we don't charge them the lab fee. You are a nice guy and I must be really cheap. I require all employees to "clock out" while they receive dental care or we do it on an off day when they know they will not be paid. I also firmly believe this stuff should be written down and reviewed by a new employee during their 90-day trial period. I even have them sign off that they have read it, understand it and agree to it as a condition of their continued employment.
FLSteve, Official Townie

The deal with insurance is you have to bill the insurance what you charge the patient after your discount (i.e. the lab fee). The staff member would then be responsible for the difference. Otherwise it is fraud!
Dkimmel, Official Townie

Let there be no doubt... that would be insurance fraud. Do this...your rules apply and don't take her insurance AT ALL. You are not obligated to accept anyone's insurance. If she insists, tell her you will file her claim legally by stating the fee was $0.

If Boris does as his assistant is suggesting...file the claim and give her the money…I'm pretty sure if the insurance company got wind of it, you'd be in a heap of trouble. He would be essentially not charging her. Then she is profiting at the expense of the insurance company, and is using his license to enable her. I would strongly caution against doing this.
Mike Barr, Official Townie

Our dental benefits are free to employees plus any lab costs. I do the work on the employee's day off or if you get a no show or have some down time. Immediate family 20% discount. If insurance the 20% is off total charge. It is written in our policy that if insurance pays more than 80% we keep the difference! If they pay less we bill the difference.
Paulcaselle, Official Townie

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Professional Advice from Dental Attorney Jeff Tonner

I feel strongly that if you billed the insurance company and the patient kept any portion of the proceeds, it would be fraud. I feel that if you kept any proceeds it likely would be fraud. The carrier may investigate (or discover this during a routine audit), and learn that your office policy is free work for the staff, and then wonder why the company was billed at all.

I have defended several DDSs in insurance fraud matters (some for only a few thousand dollars), and let me tell you it is an absolute nightmare. There are (1) federal statutes, (2) state statutes, (3) a possible contract breach with the carrier, plus (4) the local dental board.

This scenario has happened more than once. The board determines there was insurance fraud, then notifies the U.S. Attorney's office. The result can be federal civil and/or criminal charges. If criminal, then you need a second lawyer to defend you. None of this is cheap and (ready for this) all of this conduct is excluded in the standard malpractice policy. This means that any settlement, judgment, and all attorneys' fees are borne by you alone. Do NOT even think about billing for this procedure. Your small remuneration would make Judas' 30 pieces of silver look like chump change!

Jeff Tonner is a dental defense attorney in Phoenix, Arizona. His practice encompasses the dental-legal arena defending dentists in malpractice or board action. Mr. Tonner can be reached by email at dentlaw@jefftonner.com or by phone at 602-266-6060.