Posted and filed under FWA.

Do you feel blog posts are all the same?  There are some truths and useful information, and some hyperbole.

In 2020, I took my family’s dental fraud story public and then performed a deep dive into dental fraud, including issues around standards of care.  I personally formed a grim vision that nobody cares about dental FWA enough to stop it if the money isn’t there.  Do the payers really care about the waste and abuse that happens in dental?  My short answer was, no.

After taking time to truly interview and research data with my team, we found that quite simply, the dental FWA space is not backed by as many resources because dental care represents only about 5% of the country’s spending on all health care and dental waste and abuse is much softer than waste and abuse in medicine. 

We reached out to Dr. Jeff Johnston, Senior Vice President and Chief Science Officer at Delta Dental Michigan and a leading Periodontist who is an expert in the world of dental care and fraud, waste and abuse to tell us his side of the story. He had the following eye opening comments:

“Consider the costs of PPE.  Your post is not telling the whole story.  Sure, masks are cheap, but the wrong masks were cited.  Generic unfitted N95s and earloop surgical masks (Level I – III) were cited.  The correct mask is the 3M N95 mask, which is more like $8 (if you can even find one to purchase).  Plus it is not just the dentist.  All the staff needs them.  And what about the gowns? HEPAA filters, Isolite systems?  This needs to be counted as well.  Plus lost productivity  due to being only able to see half the volume of patients due to social distancing. It is easy to make a condemning case when the whole picture is not considered.”

Wow, the dental PPE is so much more than we see as consumers and we had no idea. We check our medical bills for each line and just PPE was not giving us a warm fuzzy feeling, however when we were made to understand more about the potential costs, we understood and were glad to pay.  We liked this feedback and wanted more. Keep in mind that many insurance contracts, particularly Medicaid prohibit the separate billing of PPE.

“If you think isolated billing mistakes are rare, you should think again.  We see them all the time.  When I was in practice, I made them as well.  Wrong tooth number, improper code, we see it every day.  There is nothing sinister about mistakes.  It can happen to anyone.  All we can do is strive to minimize them and correct them when discovered.” said Dr. Johnston.

Its true, everyone makes mistakes and it does not necessarily mean it is sinister and it was valuable for us hear what it sounds like from the other side. I definitely think we need to hear more from doctors who have been trying their best but get nailed by the audit monster (aka us, the government, payers etc). 

But can we know who is just making a mistake versus the “real” FWA? Are mistakes FWA?

Although we did feature Dental Fraud from a different perspective, we are going to take one more look at state boards and revoking licenses. Stay tuned and please send us your feedback if you have any thoughts.