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'Hot and emerging issues in dental benefits and the profession' in focus at conference

October 15, 2012

By Kelly Soderlund, ADA News staff

Health care reform and keeping diligent records topped the agenda at the National Dental Benefits Conference in September.

Old friends: Drs. Rodney Blaney and Nunya Irvine attended dental school together and reconnected at the National Dental Benefits Conference.

The daylong conference, held at ADA Headquarters Sept. 14 in Chicago, drew 128 dentists, dental team members, constituent and component dental society staff, consultants and other representatives from the payer industry. Dentists received up to seven continuing education credits for attending.

Attendees heard presentations on the role of dental consultants in dental benefit administration; contracts, coding and claims; payers and quality improvement initiatives; and claim reviews from executives at MetLife.

“It was a chance for groups to network, learn about the latest trends and issues in the insurance industry and hear how they can improve their practices or businesses,” said Dr. Jim Richeson, chair of the ADA Council on Dental Benefit Programs.

“I think we provided a diverse program that called attention to the hot and emerging issues in dental benefits and the profession.”

Ben Wright, chief financial officer and vice president of strategic initiatives for AmeriBen—a third party administrator—presented The Impact of Health Care Reform on Health Systems, Dental Insurance Companies and Consumers.

Mr. Wright discussed how he expects the Patient Protection and Affordable Care Act—the health reform law President Obama signed two years ago—to affect both the medical and dental industries.

Health care primer: Ben Wright, chief financial officer at AmeriBen, discusses how the new health reform law will affect the benefits industry.
“We are very much preparing for a new world on the medical side, where we are going to be playing under some different parameters,” Mr. Wright said.

Mr. Wright discussed the formation of state-based Affordable Insurance Exchanges, where consumers can shop for their own health insurance plan outside of their employer.

Each state must create an exchange to facilitate the sale of qualified medical insurance and companies can’t offer better prices outside of the exchange, he said.

“There’s going to be some very powerful incentives for people to buy their policies on the exchange,” Mr. Wright said.

He also estimated that insurance companies will be looking to move into the dental market because it will be less regulated than medical alone.

“The question is, how is dental insurance going to be sold moving forward?” Mr. Wright said.

The program also featured Dr. Roy Shelburne, a Virginia dentist who spent 19 months in a federal prison after being convicted of health care fraud. Dr. Shelburne’s dental practice was raided by the FBI in 2006 after a complaint was filed against him with the Medicaid fraud division, he said.

The government accused him of upcoding, providing unnecessary treatment to children, overtreating and billing the same claims twice, among other allegations.

Dr. Shelburne, who had to surrender his dental license, said the government believed he collected nearly $18,000 he was not entitled to and defrauded the government to fund his lavish lifestyle.

Moderator: Dr. James Richeson, chair of the ADA Council on Dental Benefit Programs, provides opening remarks at the Sept. 14 conference.

During its investigation, the government subpoenaed his patients and had experts examine them to determine whether they were given the proper care and treatment.

Dr. Shelburne takes issue with the way the examinations were conducted—in a classroom with flashlights—and said many of the experts were not dentists but hygienists, assistants and business staff.

He maintains many of the charges stem from errors in coding and incomplete patient records. Dr. Shelburne, who is still on parole, spends time talking to dentists about the importance of keeping accurate and complete records to avoid such a situation.

“I stand before you a guilty man and rightfully so,” Dr. Shelburne said. “I was paid something I was not entitled to.”

The lesson was not lost on the audience, who appeared to take to heart the sobering message about doing the right thing and coding for exactly what was performed.