Many dentists are unaware of the negative impact a dental board order can have on their practice, according to Barry Lyon, DDS.
Dr. Lyon is the dental director for Main Street Children’s Dentistry and Orthodontics and the chief clinical auditor for Dental Care Alliance. He recently spoke with Becker’s to discuss how dental board actions can affect things like insurance participation and DSO employment.
Editor’s note: This Q&A is part of a weekly series featuring Dr. Lyon focused on topics in the dental industry and DSO field. The views expressed are those of Dr. Lyon and do not necessarily reflect those of Main Street Children’s Dentistry and Orthodontics or Dental Care Alliance.
This response was lightly edited for clarity and length.
Dr. Barry Lyon: Dentists working for DSOs often feel insulated from the laws and regulations of their state dental boards relative to dentists practicing in their own offices. As a result, there is a lack of awareness of the effect a board sanctioning can have on the dentist’s participation with an insurance company or state Medicaid program.
Dental board actions against a dentist can have severe adverse financial consequences by affecting the contractual relationships with dental insurance carriers. Even if a dentist is lawfully practicing on probation or a stayed suspension, insurance carriers may terminate their contract with the dentist.
Health insurance carriers have obligations to their members to assure competent and ethical healthcare delivery. Insurance carriers may require that the license to practice dentistry remain in good standing and that the dentist abides by the carrier’s practices and procedures. Furthermore, if a carrier receives credible information concerning conduct of a dentist that could be harmful to the member, the dentist would be subject to immediate dismissal from the provider panel on that basis alone. This responsibility is monitored through utilization management, quality assurance activities and the credentialing process.
A critical part of credentialing is licensure status and history. Dental carriers may terminate their contract with a dentist if there are any active encumbrances on a practitioner’s license, regardless of the nature of the infraction. Some past dental board actions that have been rectified are usually not a barrier to contracting with a carrier, but a dentist should accurately disclose such action.
Being dropped by an insurance company because of a dental board order can have an immediate impact on their employment by a DSO. Not only can it lead to termination with cause, but finding subsequent employment may be severely hampered.
