Compliance Best Practices for Dental Providers

In March 2014, OIG excluded CSHM, LLC (which managed and operated the national chain of Small Smiles Dental Centers) from Medicare, Medicaid and all other federal healthcare programs for at least five years because of its alleged material breaches of its corporate integrity agreement (CIA) with OIG. This case exemplifies the government’s increasing scrutiny of DSOs, which otherwise have grown substantially in popularity in recent years, thanks largely to increased private equity investment.

McGuireWoods attorneys Geoffrey Cockrell, Barton Walker, Amber Walsh, Holly Carnell and John Saran, and summer associate John Harig,a discuss this case in a white paper titled “Compliance Best Practices for Dental Providers: Recent OIG Activity Highlights Need for Robust Compliance Efforts .”

Executive Summary

1. As a result of the actions of a very small minority of the dental industry, dental support organizations (DSOs) have come under increasing governmental scrutiny.
2. The need for DSOs (and dental practices, more generally) to build a “culture of compliance” is more immediate in light of this heightened scrutiny.
3. An effective compliance program begins by implementing policies and procedures that focus on both quality of care and adherence to federal and local laws and regulations.
4. Each DSO should have a chief compliance officer who maintains independence and has authority to effectively implement policies through compliance liaisons at each facility.
5. DSOs should conduct thorough training of staff on policies and procedures, as well as continually review their training and compliance programs to ensure effectiveness.
6. DSOs should respond to and correct compliance issues timely and completely.
7. Compliance programs should be designed to ensure the quality and medical necessity of care, in addition to billing accuracy.
8. Various industry participants have already adopted strong compliance programs. Further, the Association of Dental Support Organizations has developed a model Code of Ethics for its DSO members.