Tooth Cop- Protecting and Serving Dental Professionals
Tooth Cop- Protecting and Serving Dental Professionals
The Tooth Cop- AKA Duane Tinker, former investigator for the State Dental Board shares stories and tips for dentists interested in protecting their practices from regulatory problems.
Duane ' Tink' Tinker

Will Trump trump Obamacare??

11/16/2016 10:16:23 AM   |   Comments: 0   |   Views: 123

Donald Trump, whether he is an ace in the hole or a fart in the wind we have to keep on keeping on. November’s presidential election was perhaps the surprise of the century. In the aftermath, everyone on both sides of the aisle have so many questions and are filled with all kinds of speculation. What will happen with Obamacare? Will President Trump reduce our tax burden, create jobs, reduce our regulatory obligations?

 Like you, I have no answers, and have a million questions. Among my questions are:

  1. Will President Trump and congress repeal and replace Obamacare?
  2. What parts of Obamacare (if any) will they keep?
  3. How will this impact my business, my family, my employees (and their families)?
  4. Will perspective changes improve anything?

Currently dentists/ dental offices have numerous compliance requirements under Obamacare, including, non-discrimination under Section 1557, which affords equal access to government-funded health care (dental) services to citizens and non-citizens without regard to race, color, national origin, age, disability, or sex.

It is 2016 for crying out loud! I see no reason why our country shouldn’t coalesce behind non-discrimination requirements. Is anyone really better than anyone else because of race, color, national origin, age, disability or sex? Fundamentally, we are all homo sapiens with thoughts and feelings, values and imperfections. We all want the best that life has to offer, right?

On the flip side of these rights – since the government requires healthcare (including dentists) providers to provide for competent language services for Limited English Proficiency (LEP) persons it seems reasonable the government should provide compensation for these mandated services. Under section 1557 health plans and health care providers are mandated to pay for language interpretation/ translation services at the providers’ expense. Specifically, providers cannot increase their fees, create additional fees or otherwise attempt to recoup their expenses for providing services to LEP persons.

For now, though, we have Obamacare. There are no other cards on the table. You and I have to play the hand we were dealt. Here is what these hands are for dentists who participate with government-funded healthcare programs including, but not limited to Medicaid, Medicare, and Tricare (I bet the last one got your attention):

  1. Must comply with non-discrimination practices required by Section 1557.
  2. Must establish an effective healthcare compliance program+, as per Section 6401.
  3. Must minimize billing/ documentation errors to minimize/ avoid financial recoupments, as per Section 6401.

Why must you do these things? Because today Obamacare is intact and that set of laws requires these things. Donald Trump has an agenda and it is doubtful he will accomplish much of what he claims he will, as most presidents fail to fulfill their campaign promises. However, unless or until (future) President Trump and congress repeals Obamacare there are government agencies out there that are still tasked with ferreting out non-compliance with the laws they are tasked to enforce.

Additionally, there are federal, state and in some cases local laws all dentists and dental offices need to follow including, but not limited to:

  1. Patient and employee safety (OSHA, Infection Control, Dental Practice Acts, Dental Board Rules, State Radiation Regulations)
  2. Patient privacy (HIPAA Privacy)
  3. Information security (HIPAA Security)
  4. Sound documentation/ billing practices (Dental Practice Act, Dental Board Rules, State and Federal Insurance Laws, civil contractual agreements)

Between your state dental board, OSHA, Radiation Control Board, Health and Human Services – Office for Civil Rights (HHS-OCR), OIG, DOJ, OAG-MFCU (Medicaid Fraud Control), FBI, FDA, FTC, and quasi government Recovery Audit Contractors - Uncle Sam has you covered. Whoever is their commander in chief these government agencies have their respective missions and you’re it. Supervising you is the government’s mission.

While President Trump may relax enforcement of some government regulations (or maybe make some of them disappear) there is the here and now. Anticipation of changes does not merit complacency to any of these regulations. Remember, Uncle Sam still has bills to pay and Dentists are a remarkable source of Accounts Receivable since you typically have deeper pockets than the average American people. Keep in mind that the feds just gave themselves a raise by nearly doubling OSHA fines, markedly increasing HIPAA related settlements, and raising Civil Monetary Penalties associated with False Claims Act settlements from $5500-11,000 per claim to $10,781-$21,563 per claim.

Is your practice without sin? If not, maybe now is the time for confession, acts of contrition, and repentance (okay, I even scared myself with these words). I’m no preacher, but helping dentists straighten up their acts is what we do (confidentially and without judgment I might add). If your practice is not without sin, perhaps we should talk!

A former Law Enforcement Officer/ Dental Board investigator Mr. Duane Tinker is the CEO of Dental Compliance Specialists. Mr. Tinker and his compliance specialists provide compliance consulting, auditing and training services for dentists and Dental Service Organizations nationwide on compliance risks including OSHA, HIPAA, Dental Board rules/ regulations, state radiology rules, DEA and state drug regulations, and Medicaid. He often speaks for dental societies and study clubs. Mr. Tinker can be reached at (817) 755-0035.

Click HERE to learn more about our CAP-GOLD compliance plan.

+ According the U.S. Office of the Inspector General (OIG) healthcare compliance programs are expected to include: 1). Conducting internal monitoring and auditing through the performance of periodic audits; 2). Implementing compliance and practice standards through the development of written standards and procedures; 3). Designating a compliance officer or contact(s) to monitor compliance efforts and enforce practice standards; 4). Conducting appropriate training and education on practice standards and procedures; 5). Responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate Government entities; 6). Developing open lines of communication, such as (1) discussions at staff meetings regarding how to avoid erroneous or fraudulent conduct and (2) community bulletin boards, to keep practice employees updated regarding compliance activities; and 7). Enforcing disciplinary standards through well-publicized guidelines.


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