sfddaVolume 57, No. 3 www.sfdda.org Winter 2016

The First Ever

Joint Affiliate Officer

Installation and

Annual Business Meeting,

Pg.8

President’s Message, Pg.3

Ethical Considerations In the Practice of Dentistry ­Continuing the Conversation The third of a multi­part series: Financial Considerations. Pg.4

Top 5 Legal Questions,Pg. 11

Affiliate C.E. Dinner Meetings, Pg. 12

2016 Legislative Issues, Pg. 13

Classifieds, Pg. 19

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President’s MessageElaine deRoode, D.D.S.

At the South Florida District Dental Association, we cele-

brated the arrival of 2016 and hit the ground running! Feb-

ruary has not yet closed and so much has happened: The

SFDDA Lecture Series, FDA House Of Delegates (HOD),

and Dentist Day on the Hill, to name a few. Our staff and

many of our members are working hard to make this year

a memorable one that brings with it unification and

strength to our society.

Led by Dr. Irene Marron-Tarrazzi, ADA Second Vice Pres-

ident, and Chairwoman of the SFDDA delegation to the

FDA HOD, we proved to be a strong and influential team

at the FDA House this past January. Among several note-

worthy issues was a resolution requesting legislative sup-

port for a law similar to a Texas statute which requires

secondary dental insurance carriers to pay for “all,” rather

than only a portion, of a balance not paid by the primary

insurance carrier. I look forward to seeing this resolution

come to fruition in the June HOD.

Diversity, leadership, financial and personal well being was

the theme of the SFDDA Enrichment Lecture Series which

took place in three parts starting in December. Many stu-

dents, as well as members in various stages of their careers,

attended the lectures which included, Dr. Sanjiv Chopra,

Adrian Wilkins and concluded with Reese Harper, CFP ear-

lier this month. Through an interactive presentation, Mr.

Harper shared his simple formula for financial success and

retirement planning.

I would encourage you to sign up for Mr. Harper’s weekly

blog at: www.dentaladvisors.com.

Our affiliate societies have benefitted from the assistance

of our SFDDA staff, helping to check-in members and

record CE at affiliate meetings, maintaining current and ac-

curate lists of members, consolidating and streamlining so-

cial media and website links and membership applications.

This assistance has helped keep the focus of the affiliate

boards on providing their own member services, including

fascinating lectures – one of many reasons to join and to

not miss your local affiliate society meetings!

In addition, our staff has been integral in assisting new

members with their application process from start to finish.

We have seen membership at the SFDDA steadily increase

during this last fiscal year.

Finally, we are looking forward to hosting our first-ever

combined installations of the boards of all three affiliate

dental societies, and also conduct the SFDDA Annual Busi-

ness Meeting. This event will take place on May 3 at the

Kovens Conference Center on the campus of FIU in North

Miami Beach. This will be an amazing opportunity for all

affiliate societies to come together and celebrate. We look

forward to continuing this tradition, while moving the lo-

cation of the event each year to reflect each of our society’s

geographic locations.

I look forward to you joining us at this exciting upcoming

event, and the many other great future events planned for

you by our local affiliate societies!

3

The beginning of this series took place in our Summer, 2015

issue, which sought to shed light on changes occurring within our

profession over the past decade or more - and some of which have

led many of us to question the nature of what is taking place

within dentistry.

As previously mentioned, the prevailing trends of most concern

have had some relation, whether directly or indirectly, to issues

involving ethics, or ethical decision-making.

As if looking at ourselves in a metaphorical mirror, questions we

could envision asking could include those such as, “May the pro-

cedures we choose to perform on a given patient be conceivably

influenced by economic factors such as student debt, insurance

plans and/or varying dental practice models?” Or, “Is the ever-

escalating trend of itinerant dental surgical specialists (or those

who claim to be specialists) traveling to ever increasing numbers

of office locations throughout the city and state – when also con-

sidering the adequacy of preoperative evaluation and/or availabil-

ity for post-operative follow-up care – helpful or harmful to our

patients?”

“Are we performing an ever-widening scope of procedures which

may exceed our training and expertise?” “Is the ever-more-in-

vogue procedure of placing bone graft material into all or most

extraction sites truly necessary?” “Are the procedures or treat-

ment plans we recommend for our patients influenced more by

what we want to do and accomplish, as opposed to what a given

patient truly needs or wants?”

As previously said, there are many other similar questions one

could ask, imagine and discuss with one another.

Sharing A Chapter Written For an Ethics Textbook - Part 3

As I related in the opening article, I had been asked several years

ago to contribute a chapter for a textbook on the subject of ethics

in dentistry. The chapter assigned to me was entitled, “Ethical As-

pects of Referrals Within Dentistry.” And, my stated goal was to

share the chapter with you, in several sections, in the form of a

“multi-part series.”

In the first article, following introductory comments, I began the

discussion by first sharing the “preface” of the chapter, which es-

sentially set the stage with my own view of the meaning of, or

how I personally define, “ethics.”

Part 2, which appeared in our last newsletter, included general in-

formation on patient referrals among the nine specialties within

dentistry, and among others within the medical profession and

ancillary health care community. This was followed by a section

on the indications for patient referrals - i.e., having an apprecia-

tion for our own respective limitations, and knowing “when to

refer,” while also citing, as a reference, Section 2.B. of the ADA

Principles of Ethics and Professional Conduct - “Dentists shall

be obliged to seek consultation, if possible, whenever the welfare

of patients will be safeguarded or advanced by utilizing those

who have special skills, knowledge and experience.”

Other issues followed, including “misrepresentation of specialty

status or training,” as well as an appreciation for when “not to

refer” - i.e., if based on a patient’s race, religion, sexual orienta-

tion, whether a patient may have an infectious disease, such as

HIV/AIDS, or when a genuine or forthright rationale, in the name

of the best interest of the patient, is lacking.

The next section of the chapter I would like to share is based on

a topic which perhaps may not be the most convenient or com-

fortable to talk about, and perhaps not the most interesting in the

eyes of many. However – referrals, when based on financial con-

siderations, are no less important than other issues facing us in

our daily practice, and which may at times be subject to question

from an ethical perspective, or lack thereof, depending on indi-

vidual scenarios or circumstances.

Ethical Considerations In the Practice ofDentistry ­ Continuing the Conversation The third of a multi­part series: Financial Considerations

4

Richard A. Mufson, D.D.S., Editor

“… direct “kickbacks,” or “fee-splitting” … is not only regarded as unethical in the practice of medicine and dentistry, it is also a violation of the laws of most, if not all, states and jurisdictions, and a violation of federal anti- kickback legislation when federally

funded programs such as Medicare and Medicaid are involved.”

1,2

1-4

5

I would also like to repeat a previous disclaimer that (1) I do not

consider myself an expert on the topic of ethics, but feel I have

worthy information and opinions to share, and (2) if the informa-

tion may appear too “basic” or elementary at times, or you may

perceive a tone of being “lectured to,” please keep in mind that

the chapter was written as part of a text for the expressed target

audience of undergraduate and graduate dental students.

Past 3 – Ethical Considerations in the Practice of Dentistry

Referral Decisions Based on Financial Considerations

Another group of referrals, which readily opens the door to po-

tentially serious ethical questions - are those in which financial

considerations may supersede the best interests of the patient.

Three general categories of such referrals come to mind, and in-

clude those based on:

(1) direct monetary advantage, such as kickbacks, also known as

“fee-splitting,” or

(2) when a lack of monetary advantage exists, or

(3) when a monetary disadvantage plays a role.

Let us further explore examples falling within these three cate-

gories.

Category 1. Direct Monetary Advantage:

Referrals falling within this category involve a financial incentive

known as direct “kickbacks,” or “fee-splitting.” This practice is

not only regarded as unethical in the practice of medicine and

dentistry, it is also a violation of the laws of most, if not all, states

and jurisdictions, and a violation of federal anti-kickback legis-

lation when federally funded programs such as Medicare and

Medicaid are involved.

As mentioned earlier, the professions of medicine and dentistry

are different from other businesses or professions, in which a

“buyer beware” theme has no legitimate place, and patient wel-

fare is to be placed well above that of our own self-serving eco-

nomic interests. When a patient is referred to a specialist for

evaluation or treatment, patients are entitled to, and should expect

nothing less than, a professional chosen by the referring dentist

for their level of knowledge, expertise and judgment, rather than

for a reasons based on some hidden economic arrangement be-

tween the two dentists.

The ADA Principles of Ethics and Professional Conduct, under

Section 4.E., specifically deems the practice of a dentist accepting

“rebates” or “split fees” as unethical. The same practice is also

addressed and deemed unethical within the Codes of dental spe-

cialty organizations, including those of the American Association

of Oral and Maxillofacial Surgeons (AAOMS) and American As-

sociation of Orthodontists (AAO).

Such practices are also inconsistent with ethical principles men-

tioned earlier of justice (“fairness”) and veracity (“truthfulness”),

which are further addressed in Sections 4 and 5 of the ADA Prin-

ciples, and which hold that dentists have a duty to “treat people

fairly” and to be “honest and trustworthy in their dealings with

people.”

A separate question often raised when discussing the issue of fee-

splitting relates to whether this may, or may not, apply to the very

common scenario of a dentist choosing to give an occasional gift

at some point during the year (such as around the holidays) as a

token of thanks for the sharing of a good professional relation-

ship. The most common answer is that this generally does not fall

below accepted ethical standards. However, if gifts, rebates or

other remunerations are linked to specific or individual patient

referrals, it is viewed as a violation of ethics, and in many cases,

the prevailing laws as well.

Other examples of referrals based on monetary incentives, which

are not regarded as illegal, but in some instances, may be subject

to ethical questions, may occur in situations involving “group

dental practices.” A group practice is typically composed of one

or more general dentists combined with one or more dental spe-

cialists. When patient referrals are required, an incentive may at

times exist to keep the patient - along with their monetary funds

they may otherwise spend elsewhere - “in house,” by referral to

one of the dental specialists within the group practice.

It should also be stated that the referring dentist may well regard

the “in-house” specialist as highly qualified, and a very worthy

choice of practitioner to whom he or she would entrust the care

of a best friend or relative. However, a percentage of referrals

take place on a daily basis in which the referring dentist may not

feel the specialist within the group is as qualified as others outside

the group, but may be discouraged from making outside referrals

by those who own or administer the practice.

As a result, dentists within such group practices may face an eth-

ical dilemma on a daily basis, in which they are required to make

decisions as to whether to refer a patient to (a) a specialist who,

in their opinion, may be more highly qualified and a more optimal

choice for their patient, or (b) to a specialist who may be less

qualified, but may better serve the financial interests of the own-

ers or corporate administrators of the group dental practice.

The difference between these two extremes of referral choices

may not always be obvious and may, at times, instead be some-

what vague or unclear. However referrals made with the ladder

goal in mind – i.e., financial considerations taking precedence

over the best clinical interests of the patient - are regarded as a

violation of ethical principles on multiple levels. 3,4

1

1,8

As a result, dentists within such group practices may face an ethical dilemma on a daily basis, inwhich they are required to make decisions as to whether to refer a patient to (a) a specialist

who, in their opinion, may be more highly qualified and a more optimal choice for their patient, or(b) to a specialist who may be less qualified, but may better serve the financial interests of the

owners or corporate administrators of the group dental practice.

continued on page 7

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Among these could include one or more principles discussed at

the beginning of this chapter, including patient autonomy and ve-

racity. From a patient’s perspective, they would like to assume,

and by all rights should assume, that the choice of doctor they are

being referred to for care would be made with their own best in-

terest in mind, and moreover, that the process be transparent and

honest, rather than contain hidden underlying motives, such as a

financial one.

Category 2. Lack of Monetary Advantage:

An example falling within this category may include the referral

of a patient out of the office to another consulting doctor or spe-

cialist, if done so under the guise of requiring more advanced

care, but when the actual underlying reason may simply be a lack

of finances and a resultant lack of motivation to keep the patient

in the office. In many such cases, referrals take place without ef-

fective communication of the rationale for the referral or other

extenuating circumstances (i.e., financial), and may result in frus-

tration or a waste of time for a patient when going back and forth

from office to office for inappropriate reasons and without proper

communication.

The specialist, in such cases, may then choose to take the ethical

“high road,” and treat such patients with little or no finances at a

reduced cost, or pro bono (especially in more emergent situations,

such as when pain and/or swelling may be involved), or devote

time toward searching out other potential legitimate venues for

the patient and their needed care.

It must be pointed out, on the other hand, that dentists are not ob-

ligated to accept every patient who walks in their door, and may

legally and ethically decline to accept a patient for any number

of reasons, including a lack of finances. However, the previous

example given speaks more to one’s intent in referring a patient

under the premise of requiring a specialist, but when a different

hidden reason (finances) is the underlying primary motivating

factor. In the absence of any other clinical considerations or ra-

tionale, many would consider this type of referral as questionable

from an ethical point of view.

Other examples of referrals based on “lack of monetary advan-

tage” may be found among some dentists who are contracted

providers with certain dental insurance plans, in which separate

and conflicting ethical and legal interests may be involved in the

process of patient referrals.

Under some plan contracts, dentists are paid and receive a set

monthly “capitation” check in exchange for basic dental proce-

dures they have agreed to provide - and are presumed as capable

of providing - to a certain number of patients or families assigned

to that office. The monthly fee received remains the same whether

the patients choose to appoint, or choose not to appoint, for care

during a given month. And when patients do appoint, the dentist

is often not permitted to charge an additional fee (or if so, a small,

or greatly reduced, fee may be allowed) for services provided,

with the possible exception of certain “non-covered” procedures.

Aside from obvious ethical issues raised by the questionable in-

centives inherent within the very structure and design of such

plan contacts, and the resulting influence on patient care, or lack

of care, delivered, a separate set of ethical considerations may

arise as related to patient referrals.

As a result of hidden financial incentives, unsuspecting patients

may be referred to specialists – but not for the typical reasons of

requiring the higher level of expertise and care, and not taking

into account the fact that their primary dentists may well be ca-

pable and competent to provide the treatment required - but rather

for reasons involving a lack of monetary gain or reimbursement

to be made should the patient remain within the office of their

dentist.

Patients end up on the losing end when referred to a specialist for

apparent routine care, as they are destined to incur a significantly

higher cost (although in some cases, they may receive, or be en-

titled to, a discount), as compared to the same treatment the con-

tracted primary dentist could have provided, and rightfully should

have provided, under the plan contract in their own office.

Category 3. Monetary Disadvantage:

Under some of the same plan contracts, there are also situations

in which a referring dentist may stand to lose money, in the form

of deductions from the monthly capitation check, if a given paid

consultant of the insurance carrier determines that a patient was

referred to a specialist for a so-called “routine” procedure inap-

propriately, and that the primary dentist could have performed

that particular procedure in their own office.

Examples of this could include patients requiring certain en-

dodontic procedures or dental extractions, which the primary den-

tist may view as more complex than he or she is trained or capable

of performing. However, rather than refer the patient to a special-

ist – as they would ordinarily do for any similar patient not on

the insurance plan in question – the dentist may elect not to refer

and instead perform treatment on his or her own, under the pres-

sure of not wanting funds deducted from the monthly “cap

check,” and even if it were to mean the results of treatment may

be substandard.

As many experienced and prudent dentists are aware, certain teeth

requiring endodontic therapy or extraction may appear “simple”

or “routine” on a two-dimensional dental radiograph, especially

in eyes and minds of some insurance plan consultants - but yet

turn out to require a far more complex level of treatment than

Some dental plan contracts do not take this into account, but rather assume that “all teeth are created equal.” … Under such agreements, the primary/general dentist may be requiredto treat [more complex]cases rather than refer to a specialist, or if not, face the threat of a potential

monetary deduction from the monthly capitation check.

2

continued from pg 5

continued on page 9

7

We are excited to bring together for the first time, South Florida District Dental Association’s affiliate Societies

Miami Dade Dental SocietyNorth Dade-Miami Beach Dental Society

South Broward Dental Societyfor the

First Annual Officer Installation andAnnual Business Meeting.

At this special event the officers for each affiliate society as well as the SFDDA will be voted on and

installed that very night. The SFDDA will also conduct their

business meeting which will include a state of the association address by

President, Dr. Elaine deRoode and the voting of any resolutions that may be presented.

But most importantly, it will be a nice opportunity to share and celebrate the year’s accomplishments.

The evening will include dinner and entertainment. Save the Date!

May 3, 2016, 7:30pm Koven’s Conference Center

North Miami, Florida.

We look forward to seeing you there.

SFDDA

2015-2016 Officers and

Executive Council

PresidentELAINE DEROODE, D.D.S.

(305) 373-7799

Vice PresidentMark A. Limosani, D.M.D., Msc

(954) 800-3453

SecretaryJoseph Pechter, D.M.D.

(954) 981-0012

Treasurer

RODRIGO ROMANO, D.D.S., M.S.

(305) 667-8766

Immediate Past President

MARCOS DIAZ, D.D.S.

(954) 659-9990

Young Member

ENRIQUE MULLER, D.M.D.

(305) 931 0607

Trustees & FDA Line Officer

Michael D. Eggnatz, D.D.S., FDA 2nd Vice President

(954) 217-8888

Jorge Centurion, D.M.D., Trustee

305-662-22167

Beatriz Terry, D.D.S., Trustee

(305) 279-2828

Alternate Trustees

Jeannette Peña Hall, D.M.D.

Rodrigo Romano, D.D.S., M.S.

Delegates to the Executive Council from the Affiliates Societies

Carlos Sanchez D.M.D. (MDDS)

Esteban Leon, D.M.D. (MDDS)

Richard Mufson D.D.S (ND/MBDS)

Isaac Garazi, D.M.D. (ND/MBDS)

Ross Schwartz, D.M.D. (SBDS)

Affiliate Society

Presidents

Alexandra Castillo, D.M.D. (MDDS)

Chandy Samuel, D.D.S.(ND/MBDS)

Mark Limosani, D.M.D. (SBDS)

Richard A. Mufson, D.D.S., Editor

Yolanda Marrero, Managing Editor

Jackie Quintero, Advertising Manager

SFDDA NEWSLETTER

Copyright: © SFDDA 1996

Published by the South Florida

District Dental Association

420 S. Dixie Highway, Suite 2E

Coral Gables, FL 33146

Send announcements and

correspondence to the Editor:

420 S. Dixie Hwy, 2-E

Coral Gables, FL, 33146-2271

Phone: (305) 667-3647

FAX: (305) 665-7059

or email to:

sfdda@sfdda.org

Disclaimer: Opinions stated in the SFDDA Newsletterare not necessarily endorsed by the South Florida Dis-trict Dental Association, its Executive Council or Com-mittees. Advertisements printed should not be construedas an endorsement by the Association of the company,

product or service.

8

f t ä x à { x W t à xMay 3, 2016First Annual

South Florida Distr ic t Dental Associat ion & 

Aff i l iate Society Instal lat ions & Business Meet ing

expected.

Some dental plan contracts do not take this into account, but

rather assume that “all teeth are created equal.” As an example,

all single-rooted teeth (i.e., incisors, canines, certain premolars)

requiring endodontic therapy, or those with two roots (i.e., upper

first premolars, certain lower premolars or incisors) may be cat-

egorized as “routine” and less complex. Under such agreements,

the primary/general dentist may be required to treat such cases

rather than refer to a specialist, or if not, face the threat of a po-

tential monetary deduction from the monthly capitation check.

However, this makes little sense from a clinical point of view

when considering the fact that some of the more challenging en-

dodontic procedures, relative to performing adequate treatment

and obtaining a successful result for the patient, may often in-

volve teeth with only one or two roots. Upper lateral incisors, for

example, are known to have an often forgotten and under-appre-

ciated distal curvature associated with the apical third of the root,

thereby resulting in a greater number of treatment failures and/or

the requirement of endodontic retreatment or apical surgery as

compared to many other teeth.

Many single-rooted lower incisors or premolars may similarly

appear “simple” to the unsuspecting or untrained eye, but may

instead be quite complex, as they are known to have a relatively

high incidence of two canals, hidden second canals, and varying

patterns of branching and/or coalescing of canals, as compared

to other teeth. Similar hidden challenges may exist relative to

teeth requiring extraction.

The intent of this discussion is not to incorporate clinical lecture

material on oral surgery or endodontics, but rather to illustrate

the point that the clinical realities of dental treatment and the fac-

tors influencing our judgment on issues, such as when a referral

to a specialist would be appropriate and indicated for optimum

patient care and safety, may often not coincide with the views of

an insurance carrier, their plan contract, or paid consultant.

Again, as mentioned earlier, allowing financial considerations to

take precedent over that which may be in the best clinical inter-

ests of the patient, or as in the above example, allow insurance

carriers, their contracts, or paid consultants dictate decisions

which may supersede competent or optimum patient care – is re-

garded as a violation of multiple ethical principles discussed ear-

lier and alluded to throughout this chapter.

To summarize, this brings us back to the important principles

which take into account the rightful expectations of our patients

that, (a) our intent and actions take place with their best interest

in mind (beneficence, “do good”), (b) we refrain from decisions

or actions which would not be in their best interest (nonmalefi-

cence, “do no harm”), and that (c) we treat them with fairness

(justice) and honesty (veracity), and as we ourselves would ex-

pect to be treated. Also going hand in hand with the expectation

of truthfulness and lack of any hidden motives or agendas when

making referral and treatment decisions, is the right of all patients

to take part and play a role in determining their own treatment

decisions, their own self-determination, and what is in their own

best interest (patient autonomy, “self-governance”).

Future Chapter Sections Include:

- Decisions Affecting Our Choice of Specialist or Consulting

Doctor

- Proper Communication in the Referral Process

- Ethical Considerations From the Specialist/Consulting Dentist’s

Perspective

- Respect for the Referring Dentist-Patient Relationship

- Justifiable Criticism

- Choosing Words Carefully When Speaking About Others

References:

1. Principles of Ethics and Code of Professional Conduct, with

official advisory opinions, American Dental Association,

revised to 2011.

2. General Guidelines for Referring Dental Patients, American

Dental Association Council on Dental Practice, revised 2007.

3. American Association of Oral and Maxillofacial Surgeons

Code of Professional Conduct, September, 2011.

4. Principles of Ethics and Code of Professional Conduct,

American Association of Orthodontists, adopted May, 1994,

amended through May, 2009.

5. Ethics Handbook for Dentists: An Introduction to Ethics,

Professionalism, and Ethical Decision Making, American

College of Dentists, Gaithersburg, MD, 2008.

6. Mufson, RA, Dentists Talking Negatively About Dentists, East

Coast District Dental Society Newsletter, Volume 40: No 1,

pg 4-5, September/October, 1998.

This article is the third in a series on the topic of ethical consid-erations in the practice of dentistry. Dr. Mufson is the editor ofthe SFDDA Newsletter, and may be contacted at (305) 935-7501or MufsonOralSurg@aol.com

Announcement:The SFDDA is currently taking nominations for

the following leadership positions:

SFDDA Secretary - Open Seat

SFDDA Treasurer - Incumbent, Dr. Rodrigo Romano

FDA Trustee - Incumbent, Dr. Jorge Centurion

FDA Alt Trustee- Incumbent, Dr. Rodrigo Romano

To request a candidate application or to nominate someone

please call (305) 667-3647. You may also download and application at

www.sfdda.org

continued from pg 7

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WHAT ARE THE MOST FREQUENT/MOST SERIOUS DISCIPLINARY VIOLATIONS? Practicing below the standard of care is number one. Failing to maintain

adequate patient records is the second most frequent violation. It is mandatory that the board suspend or revoke your license for improper delegation and felonies under Chapter 409 (Medicaid fraud), Chapter 817 (fraudulent practices) or Chapter 893, F.S., (drug abuse prevention and control).

WHAT IS THE STANDARD OF CARE? It is what would pass as acceptable treatment among your peers. It is not perfection, but if you fall below what a reasonable doctor would have done

in the same situation, you may be liable for malpractice and disciplined. Board of Dentistry rules and Florida legislation also set forth minimum standards of care (e.g., failing to have an automatic external defibrillator in your office or not properly report-ing “adverse occurrences”).

WHAT SHOULD I KNOW ABOUT PATIENT RECORDS? A dentist must maintain written dental records for at least four years from the date the patient was last examined or treated. Usually, these dates coincide

but not always (e.g. missed appointment and emergencies). Dental records include your day-to-day patient appointments. But, note that seven years is typically the statute of repose on malpractice liability, so keep them at least that long. Also, note that participating provider agreements and hospital privileges may contractually require longer retention periods.

If you decide to destroy records of patients who are no longer active, you should refer to your written policy on records retention and management. You may destroy old records in any manner that protects patient confidentiality. If you hire a shredding company, please remember to have them sign a Business Associate agreement. Don’t throw them away in the garbage or a dumpster that is publicly accessible.

When a patient asks for records, you must provide copies of all reports and records including X-rays in a timely manner, with due regard for the patient’s health needs.

WHAT SHOULD I KNOW ABOUT “PATIENT ABANDONMENT” AND TERMINATING THE DOCTOR/PATIENT RELATIONSHIP? Improperly terminating the doctor/patient relationship is commonly known

as “patient abandonment.” If the patient suffers harm because of how you or your employees terminated the relationship, you may be held liable. Make it your writ-ten office policy to send patients leaving your practice a written notice or confirmation that your office is no longer treating them as a patient of record.

Don’t make the letter effective “immediately.” Immediate termination doesn’t give the patient enough time to locate another doctor. Please remember that you remain legally and ethically responsible for providing emergency care. Don’t deny it to them by a poorly-worded notification letter that might be admissible as evidence against you.

WHO DO I CALL IF I SEE UNLICENSED PRACTICE OF DENTISTRY OCCURRING?

Call the Unlicensed Activity Unit (ULA) hotline of the Department of Health at 1-877-HALT-ULA (1.877.425.8852) or visit their website (floridahealth.gov/

licensing-and-regulation/enforcement/report-unlicensed-activity). Unlicensed practice is a felony in Florida and should be reported immediately.

These legal questions and answers are provided by Graham Nicol Esq., FDA Chief Legal Counsel, Health Care Risk Manager, and Florida Bar Association Board Certified Specialist in Health Law.

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The Peer Review Mediation Program settles

disagreements between patients and dentists

more economically and efficiently than the legal

system and is available only to FDA members.

This program is free of charge.

FOR MORE INFORMATION

800.877.9922 • fda@floridadental.org

www.floridadental.org/peer-review

benefit NUMBER

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Miami Dade Dental SocietyDr. Alexandra Castillo

North Dade / Miami Beach Dental Society

Dr. Chandy Samuel

South Broward Dental SocietyDr. Mark Limosani

At the SFDDA, we offer many opportunities for you toreceive continuing education, participate in personalenrichment and meet and mingle with your colleagues.

There are three affiliate societies under our umbrellaincluding North Dade /Miami Beach, South Browardand Miami Dade Dental Society. Each society meetsin an area near your practice or your home, making iteasy for you to attend continuing education dinnermeetings throughout the year.

Enjoy a very nice meal while receiving CE credit atthe many interesting lectures being presented.

Whether it may be information on the latest science,technology and practice management or programsdesigned to inspire, the SFDDA and its affiliate soci-eties are always thinking of ways to help you succeed.

The Lighter Side of C.E.South Florida District Dental AssociationAffiliate Society Dinner Meetings & More

South Broward Dental SocietyAll Meetings Held at

Tropical Acres, Davie

March 9, 2016

Dr. Ozwaldo Mayoral

“Microscope Based Dentistry”

Miami Dade Dental SocietyAll Meetings Held at

Graziano’s, Coral Gables

March 8, 2016

Dr. Irene Marron

“Current Approaches to the

Assessment, Diagnosis and

Treatment of Halitosis”

April 5, 2016

Dr. Rodrigo Romano

“Regeneration”

Joining an affiliate societyis as simple as calling usat 305.667.3647or visitsfdda.org and click on

“affiliates”North Dade / Miami Beach

Dental SocietyAll Meetings Held at

Bonefish Grill, Aventura

March 1, 2016

Dr. Irwin Becker

“How Emotional Intelligence Has

Become Essential In Dental

Practice Success”

13

The FDA’s Governmental Action Committee (GAC), in collabo-

ration with the FDA Board of Trustees and the FDA House of

Delegates, prepare for each legislative session by developing an

“issues sheet” outlining dental related priorities to be addressed

during the legislative session, on the issues as they happen (please

visit www.floridadental.org for complete details and updates.

And the following represents this session’s issue sheet (with the

word “Support” or “Oppose” indicating FDA’s position on a

given issue).

Dental Care Access Account (Support) - For Repayment of

Student Loans and More

During the 2016 Legislative Session, legislation will be consid-

ered that will help provide an opportunity for dentists to practice

in underserved areas and have the ability to pay back their student

loan debt. SB 234 and HB 139 will establish dental care access

accounts for eligible dentists who are able to secure local funds

that will then be matched with state funds, while practicing in a

dental health professional shortage area, medically underserved

area or treating medically underserved populations. The Depart-

ment of Health (DOH) would be authorized to establish no more

than 10 new dental care access accounts per year. Eligible dentists

participating in this program could receive matching funds of up

to $100,000 per dentist per year for up to 5 years, if all require-

ments are met. Dentists will then be able to use these funds for

repayment of their student loans, or for investment in property,

facilities or equipment needed to set-up a dental practice. In order

to remain eligible to receive funds from the dental care access ac-

counts, dentists must agree to practice in an underserved area for

at least two years, or otherwise forfeit their eligibility and access

to the funds in the dental care access account. Additionally, a den-

tist can access these funds if he/she shows a commitment to open-

ing a private practice in one of the areas designated, maintain an

active Medicaid provider agreement, enroll in one or more Med-

icaid managed care plans, and expend sufficient capital to make

substantial progress in opening their own dental practice.

Recent reports have indicated that dental students are graduating

with an average student loan debt of $250,000 from public dental

schools and $400,000 from private dental schools. This substan-

tial amount of debt typically dictates what areas of the state den-

tists move to after graduation in order to meet their debt

obligations. It has been noted that some participants from previ-

ous student loan repayment programs have set-up their dental

practice in the area where they served out their dental student loan

repayment commitment. By providing financial support to den-

tists, more people will be given the opportunity to access quality

dental services. This program has the potential to create a win-

win situation for the state of Florida, for dental graduates and for

patients who will have access to much needed dental care.

Donate Dental Services Program (Support)

In 1997, the Florida Dental Lifeline Network and the South

Florida District Dental Association established the Donated Den-

tal Services (DDS) Program, which eventually evolved into a

statewide program supported by the Florida Dental Association.

The DDS Program allows dentists and dental laboratories to do-

nate comprehensive treatment to people with disabilities, the eld-

erly, the medically fragile, or to those who cannot afford dental

care.

Currently, 400 Florida dentists and 200 Florida dental labs par-

ticipate in the DDS Program. They have helped over 1,511 pa-

tients in Florida with seriously neglected dental problems and

have donated almost $5.8 million in dental services. These indi-

viduals would end up seeking dental care in the emergency room

if it were not for the volunteers who provide their services for

free through this program. Seeking dental care through an emer-

gency room setting is cost prohibitive and would not resolve the

patient’s underlying issue. Nationwide, with over 15,000 dentists

and 3,600 dental labs, the program has provided $250 million in

donated dental services. The FDA supports state funding for two

full-time coordinators and operating expenses for the DDS Pro-

gram through the Dental Lifeline Network at approximately

$170,000, recurring annually.

Community Water Fluoridation (Support)

Proclaimed as one of the 10 greatest public health achievements

of the 20th century by the Centers for Disease Control and Pre-

vention (CDC), community water fluoridation has proven to be

one of the most efficient and safest ways to prevent dental decay,

which is one of the most common childhood diseases. Studies

show that for more than 65 years, community water fluoridation

has resulted in a significant reduction of tooth decay among in-

dividuals of all ages, and especially those without access to reg-

ular dental care.

Fluoride is naturally occurring and is present in all water sources.

In Florida, about 77 percent of the population receive optimally

fluoridated water. Community water fluoridation is simply the

precise adjustment of the natural occurring fluoride to the level

recommended for optimal dental health. The level of concentra-

tion, established by the U.S. Public Health Service, is currently

set at 0.7 milligrams per liter. Apart from recommendations by

the CDC, the public health benefits of water fluoridation is rec-

ognized by the American Dental Association (ADA), the Ameri-

can Medical Association (AMA), the World Health Organization

(WHO) and 125 other national and international organizations.

One argument against adding fluoride to the water supply is budg-

etary restraints. The average annual cost for a community to fluor-

2016 Legislative Issues

continued on page 15

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idate its water system is estimated to range from approximately

$0.50 a year per person in large communities to approximately

$3.00 per person in small communities. Compared to the cost of

dental treatment, community water fluoridation actually provides

cost savings. For most cities, every $1 invested in water fluori-

dation saves $43 in dental treatment costs. In fact, the average

lifetime cost per person to fluoridate a water system is less than

the cost of one dental filling.

While representatives from both sides of the fluoridation issue

have expressed passionate views, the facts at hand are unequivo-

cal. In 2012, 74.6 percent of the U.S. population on public water

systems received optimally fluoridated water. Fluoridation has

been thoroughly reviewed in the United States’ court system, and

found to be a proper means of furthering public health and wel-

fare. No court of last resort has ever determined fluoridation to

be unlawful. The overwhelming weight of credible scientific ev-

idence consistently indicates that fluoridation of community

water supplies is the single most effective, safe and economical

way to prevent dental decay among citizens, regardless of their

age or socioeconomic status.

The FDA supports the optimization of fluoride levels in commu-

nity water systems in Florida and encourages the state to dedicate

$1 million in recurring general revenue to continue these efforts

locally.

Sunset Review of Medicaid Dental Services (Support)

During the 2011 Session, legislation passed to transition all Med-

icaid services to managed care by October 2014. This means that

health care providers who participated in the Medicaid program

no longer contract directly with the Agency for Health Care Ad-

ministration (AHCA) to provide services. Instead, providers are

required to contract with a managed care company directly for

services and reimbursements to participate in the Medicaid pro-

gram. Prior to the transition, pediatric dental care was provided

through the prepaid dental health plan (PDHP), under which

AHCA contracted with MCNA and DentaQuest dental managed

care plans, to provide services.

As the state transitioned all Medicaid recipients into managed

care plans, the FDA supported keeping dental funds separate from

medical funds. Funding for dental services in the state budget is

extremely limited. Of the $24 billion Medicaid budget, less than

one percent is spent on dental care. The FDA supports the sepa-

rate payment methodology for Medicaid dental services. This

would result in a less complicated system and ensure that more

tax dollars go toward patient care and less towards program ad-

ministration.

SB 994 by Joe Negron (R-Palm City) and HB 819 by Rep. Jose

Felix Diaz (R-Miami) are supported by the FDA. Encounter data

is crucial in determining whether dental services are actually

being utilized in a managed care model. To that end, this legisla-

tion requires AHCA to prepare a comprehensive report on dental

services provided under the Medicaid Managed Medical Assis-

tance (MMA) program, which combined medical and dental care

under the same program.

The report is due by Dec. 1, 2016 and must examine the effec-

tiveness of the MMA plans to:

• Increase patient access to dental care

• Improve dental health

• Achieve satisfactory outcomes for Medicaid recipients and the

dental provider community

• Provide outreach to Medicaid recipients

• Deliver value and transparency regarding the dollars intended

for – and actually spent on – dental services

The Legislature will use this report to determine whether to sep-

arate dental from medical in the MMA program. If the Legislature

fails to take action on this issue during the 2017 Session – or be-

fore July 1, 2017 – AHCA must move ahead with implementing

a statewide Medicaid prepaid dental health plan for children and

adults that is separate from medical, and use at least two dental

managed-care plans, which was the system used for pediatric den-

tal care before the state transitioned all Medicaid to the MMA.

Increase Medicaid Dental Funding (Support)

Florida’s $24 billion Medicaid program does not provide ade-

quate resources for dental care. Funds appropriated to dental care

in the Medicaid program make up only about 1% of the overall

Medicaid budget. The FDA supports an increase in the overall

funding of the Medicaid dental program and a thorough assess-

ment of the policies and administration of the program. Extremely

low reimbursement rates for Medicaid dental providers have been

a significant barrier for increasing the number of dentists willing

to participate in the Medicaid program.

During the 2011 Legislative Session, the Legislature approved a

$56 million reimbursement fee increase for children dental serv-

ices only. The FDA applauds the Legislature’s effort to address

an area of the Medicaid program that has not seen any significant

changes in over 20 years. However, even with this fee increase,

Florida still ranks in the bottom of all states for Medicaid reim-

bursement rates. Current Florida Medicaid reimbursement rates

are 36 percent of private dental insurance rates. Under the

statewide managed care program, the medical plans contract di-

rectly with the dentists or through a dental managed care plan and

the majority of the plans continue to set the reimbursement rates

at the Florida Medicaid rate. There needs to be a larger portion

of money designated specifically for dental care in the Medicaid

program so the plans have the ability to increase the reimburse-

ment rates for dental care.

Maintain Educational Standards for Internationally Trained

Dentists (SUPPORT)

Current law requires that graduates of non-acccredited dental

schools complete a 2-year supplemental general dentistry educa-

tion program before taking the Florida licensure exam. The pur-

pose of the supplemental education program is to: 1) ensure that

internationally-trained dentists attain the same knowledge and

skills as graduates of accredited programs and 2) familiarize in-

ternationally-trained dentists with the oral health care delivery

system in the U.S., including the techniques, procedures and stan-

dards of oral health care.

In the past, there have been legislative efforts that tried to create

a “back-door” pathway to licensure in Florida for internationally-

trained dentists. There have been proposed changes to the current

continued on page 17 15

continued from pg 13

Dr. Harold Menchel limits his private practice to treatment of TMD andorofacial pain in Coral Springs.

TMD Headache Neuropathic pain Sleep disordered breathing (OSA) Dr. Menchel coordinates treatment with restorative dentists,orthodontists, endodontists, and oral surgeons for these complexpatients.

Dr. Menchel has been in practice in S. Florida since 1981. He received themajority of his training at the University of Florida Parker Mahan FacialPain Center under the tutelage of Drs. Mahan and Gremillion from 19921999. He achieved the prestigious Diplomate of the American Board ofOrofacial Pain in 2000.

Treatment includes: (partial list) Splint therapy, medical management, physical therapy,joint mobilization, diagnostic and therapeutic injections.

All referrals will be respected and appreciated.1720 University Drive, Suite 301, Coral Springs, FL 33071(954) 345 2264website; tmjtherapy.com

Finally…a place to send those difficult patients!

TThe 2016 ACDDA Annual Conference

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Friday, April 1, 2016Embassy Suites

1601 Belvedere RoadWest Palm Beach, FL

Check-in 8:30am - Meeting 9:00am - 4:00pmregister on line at www.acdda.org

law that would provide exemptions for internationally-trained

dentists who agree to treat Medicaid recipients in exchange for

bypassing the supplemental education requirement. The FDA be-

lieves that all Floridians should have access to the same standard

of care regardless of economic status. These supplemental edu-

cation programs are offered to ensure that a minimum standard

of care for Floridians is consistently achieved for all licensees in

the state. The FDA supports maintaining the current supplemental

education requirement for internationally-trained dentists.

Florida’s Action for Dental Health (SUPPORT)

In February 2015, the FDA rolled-out Florida’s Action for Dental

Health, a comprehensive plan developed to implement initiatives

that will focus on improving the oral health, and resulting overall

health, of all Floridians. Since then, the FDA has been involved

in supporting initiatives like the Community Dental Health Co-

ordinator (CDHC), who serves as a patient navigator helping in-

dividuals access available dental care in their communities. By

incorporating the CDHC into the dental workforce, patients will

benefit from coordination of care, educational and social inter-

ventions in the community, and prevention. CDHC’s work under

the dentist’s supervision in clinics, schools, and other public

health settings with people of similar ethnic and cultural back-

grounds. They will also be able to provide limited clinical serv-

ices such as radiographs, fluoride treatments, sealants and coronal

polishing.

During a radio interview with WFSU/NPR affiliate on Florida’s

Action for Dental Health, a concerned parent called the radio sta-

tion to inform listeners that as a foster parent, he was unable to

find a dentist who could treat his foster child because the state

had not contracted with a managed care company in his local

community. Based on this information, the FDA contacted the

DOH to look into this situation. As a result, the DOH eventually

finalized an agreement with a dental managed care plan to pro-

vide dental care to foster children in eight counties: Jefferson,

Leon, Madison, Marion, Suwannee, Taylor, Volusia and Wakulla.

The FDA applauds the work of the DOH and their continued sup-

port in improving access to dental care.

These are a few examples of the many accomplishments achieved

by the efforts of Florida’s Action for Dental Health. The FDA will

continue to work on this plan and look forward to many more

success stories.

Medicaid Reimbursement for Dental Hygienists (Oppose)

The FDA opposes issuing a separate Medicaid provider number

to dental hygienists for the limited services that may be provided

in public health access settings. Current law is adequate and flex-

ible enough to allow hygienists to collaborate as needed in order

to utilize existing provider numbers that are already assigned to

dentists and physicians.

This information was reprinted with the permission of the Florida Den-tal Association and the Governmental Affairs Office.

FDA Staff Contacts:

- Joe Anne Hart, Director of Governmental Affairs: jahart@florida

- Alexandra Abboud, Governmental Affairs Coordinator:

aabboud@floridadental.org

- Casey Stoutamire, Lobbyist: cstoutamire@floridadental.org

(800) 326-0051 or (850) 224-1089

Get the latest legislative updates at

www.floridadental.org/members/governmental-affairs/legislative-ac-

tion-center/capital-report

17

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CAPITAL REPORT

continued from pg 15

Classifieds

OPPORTUNITIES

AVAILABLE

FAMILY DENTIST: Hallandale Beach fam-

ily-owned, private practice seeks team-oriented

doctor to treat adults and children. You must

have at least 3 years of experience in these

areas, and willing to become a Medicad

provider for children, if you are not one al-

ready. Adult patients will be seen on a fee for

service or private insurance basis. You must be

available to work in our office 2-4 days each

week. We prefer that you are bilingual in Eng-

lish and Spanish. Please email your CV, includ-

ing current contact information, and the days

and times that you are available to meet with

us, to southeastfloridadental@live.com

PEDIATRIC DENTIST: This is a tremen-

dous earning opportunity for a Pediatric Den-

tist to join a high quality single owned

multi-specialty practice. These highly success-

ful dental practices are located in Country

Walk and West Kendall. FT or PT, could lead

to partnership. Start working immediately.

Please contact Dr. Nick Lekkas 954-383-4973

or email drnicklekkas@altimadentalgroup.com

DENTAL ASSISTANT: Pediatric/General

Dental Practice is seeking a experienced dental

assistant for operative assisting, and prophy-

laxis treatment. You must be bi-lingual in Eng-

lish and Spanish, or English and Russian.

Expanded Duties Certification, and experience

assisting in orthodontic treatment are both val-

ued highly. Benefits will be offered to qualified

employees. Please email your resume, includ-

ing current contact information, and the days

and times that you are available to meet with

us, to southeastfloridadental@live.com

ORTHO/PEDONTIST/ENDODONTIST:

Excellent opportunity for associate dentist po-

sition available PT. Start working immediately

2 Locations Miami/Aventura area. State-of-

Art facilities. Please fax resume to (305) 553-

9688 or email to

onestopsmileshop@hotmail.com

PART TIME: High quality prosthodontist and

periodontist needed for selective cases at my

office. Please call or e-mail. David Vine,

D.D.S. 305.538.1115 ( dvine@davidvineden-

tist.com ).

SEEKING: an “on call” substitute General

Dentist in Dade Co. Salary Negotiable. Ideal

opportunity for retired or persons needing extra

income. Please call for details. Judy Jones 615-

202-8864

ORTHODONTIST: Hallandale Beach fam-

ily-owned, private practice seeks team-oriented

Orthodontist with at least 3 years of expierence

in your specialty to work in our office one day

each week. Please email your CV, including

current contact information, and the days and

times that you are available to meet with us, to

southeastfloridadental@live.com

PEDIATRIC DENTIST WANTED: Excel-

lent opportunity for Pediatric Dentist to share

office space in a well established Orthodontic

practice in Plantation Fl. Office is available 1-

3 days per week. Ideal location in a spacious

& modern facility located directly next to a

large Pediatrician group practice. Perfect situ-

ation for an initial start up or satellite office lo-

cation. Contact: pltnortho@gmail.com

A BLOCKBUSTER OPPORTUNITY: Full

or part time for General Dentists, Pedodontists,

Periodontists, Oral Surgeons, Orthodontists

and Endodontists. Generous compensation

with unlimited potential. Guaranteed referrals.

Join our group specialty care practice with a

significant general dental component. Estab-

lished in 1975 in Aventura, Coral Springs, Del-

ray Beach, Boynton Beach, Stuart, Ft. Pierce

and Melbourne. Call: Kelly Oliver at (954)

461-0172. Fax resume to: (954) 678-9539.

Email: careers@dentaland.net.

FLORIDA (SOUTHEAST AND OR-

LANDO): Seeking experienced General Den-

tists and Specialists to come grow with us! We

offer excellent earning potential and the oppor-

tunity to focus on patient care in our state-of-

the-art facilities. We take care of the

administration (insurance claims,

payroll/staffing, marketing, etc.) for you so that

you can enjoy a work-life balance again! Take

the next step in your career and apply online

at www.gentledentalgroup.com/career or email

your CV to

careers@gentledentalgroup.com today!

ORTHODONTIST WANTED: We are a

growing dental group looking for an Orthodon-

tist to join our dental team. Excellent compen-

sation. English/Spanish required. Call Manuel

305.915.2953

GENERAL / SPECIALIST: Ft/Pt Great op-

portunity for General Dentist / Specialist. Ex-

cellent compensation, bonus and partnership

positions. Multiple locations in South Florida.

Please fax resume to (305) 770-1232 or call

Kathy (954) 430-2188 or email to

haroldhui@aol.com

GENERAL DENTIST WANTED: Hialeah,

Pembroke Pines or Kendall area, excellent

compensation and bonus with guarantee in-

come. Eng/Spanish required. Call Manuel

305.915.2953

BUSY DENTAL PRACTICE: Looking for

PT associate dentist in Fort Lauderdale and

Delrey Beach. Competitive % compensation

based upon experience. Ask Dr. Martin 786-

525-9946

OFFICE SPACE-SALE

OR RENT

HALLANDALE BEACH: Practice for sale,

3ops, FFS/PPO. Located in a professional

building. Nice equipment, good lease terms.

Dr. relocating out of state. For details call (954)

471-7569 or email claus22h@yahoo.com

SPACE AVAILABLE TO SHARE: 1300 Ft.

facility in NMB near I-95 and Aventura. Only

utilized 2+days Dr. Steven Rifkin

srifkindds@gmail.com

DOWNTOWN BOCA RATON: 2450 SF of-

fice. Move in ready. 4 private treatment rooms,

2 hygienist stations, lab, private office w/

shower. Immediate occupancy. $28 PSF. Call

Lee at (561) 392-8894 or e-mail at

Lburke@bbbins.com

Buy, sell, hire, or announce?

Place advertising in the SFDDA Newsletter

Call Ms. Jackie Quintero at(305) 667-3647 ext. 13.

Or visit us on-line at www.sfdda.org

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