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New York attorney general takes action against Aspen Dental

June 19, 2015

By Kelly Soderlund

New York City — The New York attorney general announced June 18 a settlement with Aspen Dental Management Inc. that requires the company to pay a $450,000 penalty, remove itself from any clinical decisions within its practices, not split patients' fees with the clinics and make it clear to consumers that the management company is not a provider of dental services.

Under the agreement, which only pertains to Aspen Dental Management's affiliated practices in New York, the company must stop exercising any control over dental practices' clinical decision-making and will not communicate directly with practices' clinical staff concerning the provision of dental care, sales of services or products to patients or the amount of revenue generated by services or products, according to a news release from Attorney General Eric T. Schneiderman. The company will not be the employer of the practices' clinical staff or place limitations on dental practice owners' practice of dentistry, according to the release.

“The dentist’s primary obligation is to put the needs of the patient first,” ADA President Maxine Feinberg said in regards to the settlement. "The ADA strongly advocates for noninterference in clinical decision-making and we're pleased to see that this agreement supports this view. Decisions about dental care should be between the patient and the dentist."

Aspen Dental Management Inc. is a dental service provider based in East Syracuse, New York, that provides business support and administrative services to seven independently owned dental practices that maintain 40 offices in the state. Company representatives took issue with the news release issued by the attorney general's office, stating it mischaracterized the agreement and that the company has never made clinical decisions on behalf of its dentists.

The settlement requires Aspen Dental not to share in the dental practices' fees for professional services rendered; to keep the practices' finances separate from its own; and to allow the practices to have full and complete control over their revenues, profits, incomes, disbursements, bank accounts and other financial matters and decisions. Aspen Dental Management also agreed to reform its marketing practices, making clear to consumers on its website and elsewhere that Aspen Dental Management provides only administrative and business support services to dental practices that are independently owned and operated by licensed dentists, according to the AG's office.

Aspen Dental Management will also take steps to ensure its dental practices post their own legal name so that it's easily visible to patients. The company must pay an independent monitor that will oversee the terms of the settlement over a three-year period, according to the AG news release.

The ruling came after the attorney general's office received more than 300 complaints since 2005 about consumers' experiences at Aspen Dental affiliated offices across New York, according to the news release. The complaints concerned quality of care, billing practices, misleading advertising, upselling of medical services and products the consumers felt were unnecessary and unclear or incomplete terms for the financing of dental care, according to the AG's office.

"The investigation revealed that Aspen Dental did not merely provide arms-length, back-end business and administrative support to independent dental practices," the news release states. "Rather, Aspen Dental Management has developed what amounts to a chain of dental practices technically owned by individual dentists but which, in violation of New York law, were subject to extensive control by Aspen Dental Management. That control included sharing individual clinic profits with the management company and the marketing by the management company under the shared Aspen Dental trade name."

The AG's office also said Aspen Dental Management incentivized and pressured staff to increase sales of dental services and products, implementing revenue-oriented patient scheduling systems and hired and oversaw clinical staff, including associate dentists and dental hygienists. An example of the company dictating patient care, according to the AG's office, was sending "Hygiene Service Announcements" to dental hygienists, which directed them to sell more products and services to patients and training office managers on how to talk to patients about their treatment plans and help them make decisions about treatment alternatives.

Representatives from Aspen Dental Management contend the company has never employed clinical staff nor has it exercised any control over clinical care and only provides nonclinical business support services to its independently owned and operated dental practices.

"We are deeply disappointed with the characterization of Aspen Dental Management, Inc. in a press release issued today by the Office of the Attorney General of the State of New York, which does not accurately reflect the terms of the Assurance of Discontinuance, reached after three years of discussions," according to a statement released by the company. "Contrary to the headline of the press release, ADMI does not, nor has it ever, made decisions about clinical care for the 1.2 million patients who visited independently owned and operated Aspen Dental-branded practices in New York State over the past 10 years. To suggest that the dentists only "technically" own their practices is a gross misstatement of fact. Today, and every day, the owners of these practices are in their offices, treating patients and exercising complete control over all clinical decisions."

The New York State Dental Association voiced its approval of the attorney general's office recognizing the dentist's position as the superior clinical decision maker.

"The New York State Dental Association appreciates Attorney General Schneiderman's understanding of the importance of the role of the dentist in providing the diagnosis and treatment of the dental patient," said Dr. Mark Feldman, executive director of the NYSDA. "We feel certain that all dental practices in New York will adhere to this important principle."

Aspen Dental Management representatives say their primary mission of caring for patients will not change, despite the terms of the settlement.
"The focus at ADMI remains the same: We care for the people who care for the patients by providing business support to the independent dentists who own and operate Aspen Dental-branded practices," according to the company's statement. "With ADMI supporting the administrative and nonclinical aspects of their business, dentists are free to do what they do best: care for their patients."