Guest Post – Be Aware of Your “New Dental Plans”

Chris Tayler, MBA

www.cobaltanalytics.net


Navigating the world of dental plan contracts and reimbursements can be like reading legal documents written in Sanskrit through a tinted glass window. And yet the results can make a big difference in your write-offs and subsequent take home pay.

This is particularly true with companies that act as administrators/lessors and/or “networks” of dental plans. In essence these administrator networks sell and sometimes administer other dental plans.

The big question is which fee schedule the dentist will be paid from. This question arises because administrator networks and the dental plans which they sell have their own distinct fee schedules and often reimburse at vastly different rates. The difference in reimbursement for crowns alone can be in the hundreds of dollars. The point at which we attempt to determine the fee schedule used for payment is the point at which we jump into the rabbit’s hole.

When a dentist contracts directly with the administrator network she might be automatically enrolled with all dental plans within its network. Surprise!

To complicate matters, the administrator network may pay from its own fee schedule if the fee in question is lower than that of one of the dental plans within its network. However, what happens if the dentist is not directly contracted with the administrator network itself, but is contracted with one of the dental plans within its network? In that case he would most likely be paid from the fee schedule of the latter. To make things even more convoluted, at times a dentist is directly contracted with multiple dental plans sold within an administrator network, while not being directly contracted with that administered network. In that case, the fee schedule used for reimbursement is usually that of the dental plan which was directly contracted with first.

Most administrator network contracts state they administer and/or sell multiple dental plans (although they don’t always publish the full list.) Be careful, because they do not always spell this out. As a result, dentists could be paid from different fee schedules without even being aware that it’s happening, resulting in less take home pay.

You can opt out of unwanted dental plans associated with the administrator network after directly contracting with them, but it can take months for this to be finalized. In the meantime, most require the dentist to continue seeing their patients at the contracted reimbursement rates. To avoid this, you can opt-out of unwanted dental plans before directly contracting.

A key phrase here is “directly contracted.” Some administrator networks may attempt to auto- enroll (or contract) practices with the dental plans in their network without formal notification. Therefore, it is highly recommended to contact the administrator networks to find out if you are directly contracted with them, as well as with any dental plans they sell or administer. It is not uncommon to be told by the administrator network that you must reach out to a dental plan directly. If this occurs, tell the administrator network you first need to know if you are “directly contracted” with them. If they say yes, have them send you the fee schedule they are reimbursing you from (you could use this opportunity to opt-out of any of their associated dental plans.)

The next step is to reach out to any dental plans the administrator network may have mentioned to determine if you are “directly contracted” with them. This dental plan, in turn, may try to direct you to yet another dental plan, or back to the administrator. Keep in mind; however, that each one is responsible (and only able) to answer for themselves.

Most importantly, before contracting with administrator networks it would be immensely helpful to determine which dental plans are the most profitable for your practice. Having this information gives you control (and protects your take home pay) by allowing you to make informed business decisions about the administrator networks and dental plans you wish to work with.

For more information, check out Cobalt’s website at www.cobaltanalytics.net or call 801-953-9777.

Wow! Brian Nordan, Former Manager of Indiana Practices, Accused of Embezzling $3 million. Facing Federal Charges

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Brian Nordan

The former general manager of Afdent Dentistry, which has offices in Mishawaka and Fort Wayne, has been charged in federal court with defrauding the company of more than $3 million over six years.

According to an indictment filed in federal court, Brian Nordan, 42, embezzled money from Afdent beginning in 2012 for the benefit of himself, his partner and spouse, Dustin Coleman, and his sister, Angela Jasinski.

In addition to creating a separate company that sold marked-up toothpaste to Afdent for $25 a tube, federal prosecutors allege that Nordan used company credit cards to pay off his personal credit cards, make purchases at Lowe’s and pay his husband and sister salaries while they weren’t working for the company.

According to a separate civil case filed by Afdent, Nordan was terminated in June 2018 after the company discovered Jasinski and Coleman had been secretly receiving pay. Legal filings state that Afdent’s owner was unaware of Jasinski and Coleman’s ghost employment.

Nordan, Coleman and Jasinski were all arrested on multiple felony wire fraud charges on Monday and Tuesday, according to federal court filings.

“Employers hire individuals with the understanding that they will be honest and not exploit them for personal financial gain,” said United States Attorney Thomas L. Kirsch II. “When, as alleged in this indictment, individuals do exploit their employers for illegal financial gain, my Office and our law enforcement partners will investigate and prosecute.”

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Content retrieved from https://www.southbendtribune.com/news/business/former-afdent-manager-accused-of-million-fraud/article_24bbfe97-296c-518e-8970-4ecb7f9432b9.html

A Non-dentist Owner of a Minnesota Dental Practice is Charged with $100k of Medicaid Fraud

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Nadine Royter

According to the Minnesota Attorney General, Nadine Royter, 57, of Plymouth, an owner of Willow Grove Family Dental, billed for over $100,000 of services using the identity of dentist B.L. who had resigned from Willow Grove due to concerns with Royter’s unethical business practices. In one instance, Royter billed for dentures purportedly provided by B.L. to patient W.B.  W.B. told investigators he never received dentures.

Content was retrieved from https://www.ag.state.mn.us/Office/Communications/2019/09/27_MedicaidFraud.asp


A bit of digging on Ms. Royter reveals that this is not her only legal trouble. She is also facing a 2018 shoplifting charge:

Nov. 1, 2018, 400 Prairie Center Drive: Eden Prairie police responded to Von Maur at 400 Prairie Center Drive on report of a theft, according to a Hennepin County criminal complaint. Upon arrival, officers learned that a woman later identified as Nadine Royter, 57, had shoplifted items with a total value of $1,001, the complaint said. Security video showed Royter selecting items throughout the store and leaving without attempting to pay. In a search related to arrest, officers recovered the stolen items from Royter, the complaint said. She is charged with felony theft.

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Content retrieved from https://www.swnewsmedia.com/eden_prairie_news/news/public_safety/police_reports/police-report/article_4b4b8f16-f614-5507-81b0-5ee21437207a.html


There was also a person with the same name with several charges in Minnesota from 2000-2001:

First and Last Name Nadine Royter
Charges Filed Nov. 16, 2000
Source Administrative Office Of Courts (Minnesota)
Charges/Offenses Theft – $201 – $500 | Disobeying Stop or Yield Signs
Match Rating Based On:
First Name
Last Name
DOB
Age
County

First and Last Name Nadine Royter
Convicted Apr. 5, 2001
Source Dept Of Public Safety (Minnesota)
Charge/Offense Theft – Acts Constituting


Indiana Woman Charged with Embezzling $300k from Orthodontist

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Malinda Downey

A long-time employee of a local dental office has been arrested in connection with the alleged theft of nearly $300,000 from her employer over at least a four-year period beginning in 2015.

Malinda A. Downey, 47, of Madison, has been charged with one count of theft, a Level 5 felony, but additional charges could be forthcoming as accountants, Indiana State Police and the Jefferson County Prosecutors Office continue investigating the case.

Downey is currently free on a $10,000 cash bond. She appeared in Jefferson Superior Court Friday, for a reading of the charges and a “not guilty” plea was entered with her trial date set for 8:30 a.m. on Thursday, Jan. 16, 2020.

Downey, who was arrested by state police Wednesday, had been employed as an office worker at Pawlak Orthodontics, 160 Demaree Drive, Madison, for 17 years using both Ortho-Trac and Quickbooks programs to track customer payments, services and patient information before depositing receipts in the bank account for the business.

According to a probable cause affidavit, Dr. Elizabeth Pawlak, owner of the practice, had suspected discrepancies in receipts and deposits for some time but on July 11 and July 12 discovered that cash payments from two new patients were not properly documented. Pawlak then conducted a review that confirmed payments recorded in Quickbooks did not match those recorded in Ortho-Trac and an estimated $150,000 could not be accounted for.

At that point, Pawlak asked Indiana State Police to investigate the case and Det. David Makowsky advised Pawlak to seek a complete audit of her books.

The affidavit said Pawlak spoke with Downey about the discrepancies on Aug. 12 with Makowsky present and Downey indicated that she must have recorded the transaction incorrectly. When confronted with other discrepancies, Downey did not have an explanation for the missing funds.

Eventually, Makowsky asked Downey how much money was missing and she told him she “did not know.” He asked if she had taken any money prior to 2014 and she said she “didn’t think so” and that she “did not remember if she ever put any money back,” the affidavit said.

At that point Downey said she did not want to speak to Makowsky any further. They set up a time to meet the following day but prior to that Downey notified Makowsky that she did not want to meet with him further.

Autumn Dean, an accountant with Hartman and Williams LLC, completed an audit of the records at Pawlak Orthodontics and, based on a summary between the Ortho-trac and Quickbooks records, $292,251.32 was found missing between 2014 and 2019, the affidavit said.

Dean’s report indicated that a sample comparison of Ortho-Trac entries made under Downey’s login credentials compared to payments recorded in Quickbooks from 2015 to 2019 showed that payments were recorded in Ortho-Trac but not in Quickbooks and that $74,078.00 was missing in Quickbooks. Additional transactions still are being scrutinized.

The investigation led to Wednesday’s warrant issued for Downey’s arrest on the Level 5 felony charge of theft (over $50,000). She was booked at the Jefferson County Jail and later released on bond.

Pawlak has since issued a statement to reassure patients that the thefts that are charged were from Pawlak and not customers.

“We at Pawlak Orthodontics want to thank our patients for being dedicated to our office. We appreciate the loyalty you have shown us. We have had an unfortunate situation occur. A former employee has been charged with theft of funds from our office. We want to assure everyone that this has not affected any patient’s accounts. These were cash-only payments and only affected the bottom line for Dr. Pawlak.

“We want to assure everyone that we have taken measures to make sure that something like this will not occur again. Again, we sincerely appreciate the support and patience we have received from everyone while we deal with this issue.”

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Content retrieved from https://madisoncourier.com/Content/News/News/Article/Employee-charged-with-300K-theft-from-local-dentist/178/961/117559

Pennsylvania Dental Assistant Sentenced to One Year for Forging Prescriptions

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Belinda Dietrich

A former receptionist of a Harrisburg dentist will spend a year and a day in federal prison for forging 164 opioid prescriptions, according to the Department of Justice.

Belinda Dietrich, 63, will spend three years on probation following her prison time, according to the DOJ.

Dietrich was sentenced Monday on the counts of distributing a controlled substance and making false statements in health care matters, which she pleaded guilty to in April, the DOJ said.

U.S. Attorney David Freed said Dietrich was the former receptionist of a solo dental provider in Harrisburg. Freed gave an example of how the scheme played out.

Dietrich forged the signature of her employer on a blank prescription form on Feb. 13, 2017, Freed said.

The prescription, written for her mother who was not a patient of the dentist, was for oxycodone, Freed said. Dietrich’s mother was also a Medicare beneficiary.

Dietrich had the prescription for 24 pills filled at a Harrisburg-area pharmacy and kept the drugs for her own use. Medicare paid the claim, Freed said.

Between Feb. 17, 2016 and August 2017, Dietrich forged 164 prescriptions for oxycodone and hydrocodone, the DOJ said. Dietrich filled out 10 of the fake prescriptions under her own name, and the rest were written under the names of 11 family and friends.

The prescriptions were filled and the drugs were shared between the group. More than 5,022 pills were obtained through these forgeries, the DOJ said, and all 11 people were prosecuted in connection with the case.

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Content retrieved from https://www.pennlive.com/news/2019/10/central-pa-woman-sentenced-on-charges-of-forging-164-opioid-prescriptions.html