My team knew I preferred not to be interrupted while treating a patient. When Izabel buzzed I knew there was something wrong. She began, "Dr. Orent, there's a man here to see you. Says he is an investigator from the Massachusetts State Licensing Board... the Board of Registration in Dentistry. He showed me his badge. Says he wants access... to all of our patient records."
His visit was without warning. Unannounced. I had no idea why he was at my front desk. What I did know was that it's never good news. I told Izabel to tell him I'd be right out. Told my patient I was going to give him a short break... rest his jaw... then headed for the front desk.
His name was Vincent, though he introduced himself as "Investigator Smith" (not his real last name). He was wearing a dark gray suit. Showed me his badge. As he had explained to Izabel, he was sent by BORID (The Massachusetts State Board of Registration in Dentistry) as part of an investigation. He was polite, but all business. He advised me that he would be with us for the better part of the day (now there's an oxymoron... I didn't see how having him with us would make that the better part of my day).
And so it began. He pulled bunches of charts from the wall, spread them out on the desk, and began reading. When he finished that batch he'd put them back and pull the next. I went back to patient care. From time to time I'd peak out front. He was in my office no less than 6 hours. One time while at the front, I casually asked him what he was looking for. Why was he in my office? His only answer was, "I can't comment on an ongoing investigation."
George Orwell 1984
Are you old enough to remember when that book was written... about the future?! I couldn't help but think that his guy was sent by "Big Brother" and perhaps George Orwell himself. He shows up at the front desk and tells Izabel to summon me while I'm with a patient. Tells me he's going to need access to all of my patient records. Plunks himself down for most of (not the "better part") the day.
As I think about how he (and the STATE) made me feel that day, this picture pops up in my mind of the late 1960's British TV series, "The Prisoner." The star of the series, a secret agent who'd resigned from his job, was captured one day, without warning, without explanation, and imprisoned on a "resort" island. Though he was never restrained, there was noone there to ask why... and if he tried to get off the island, he was promptly brought back. He was a prisoner in paradise, of sorts. Hardly.
The Investigator Speaks
At the end of the day Investigator Smith finally spoke to me. "Dr. Orent, thank you. you made my job easy. So often I can't read the case notes, or worse, there are minimal or no case notes. Your notes were legible and incredibly thorough. Have a nice evening." Then he left. I never saw him again. Never heard from the board. To this day I have no clue what they were looking for. Was it a patient complaint? Terminated staff member rant? Perhaps a routine random check (I think not). Regardless, I appear to have dodged a bullet.
I hope you never meet a state board investigator. Chances are, you might. If you do, there are a few things that just might help your case, whatever that case may be...
1. Complete, thorough, accurate and LEGIBLE case notes.
2. Accurate insurance coding. There are more instances of dentists committing insurance fraud than you could imagine. In many cases the dentists don't even realize that what they are doing is illegal.
3. Whatever you tell a patient (with respect to treatment) should be entered into the record.
4. Everything you use should be detailed in the chart. Not just what type of anesthetic but how many carpules and what type of injection, what gauge and length needle. Be specific and thorough. If you took an impression which impression material did you use? If you cemented a temporary which temp cement? If the patient had any difficulty with the appointment, the treatment, between appointments... detail it in the record.
5. BONUS GEM COULD SAVE YOU A FORTUNE: One last thing. Insurance companies are becoming more and more aggressive (BULLYING) saying that you have been flagged for performing a higher percentage of X or Y restorations than other dentists. Then they come into your office (much like the guy from BORID did to me) and they start pulling charts. Only difference is that it never ends well. Often times the insurance company follows up with a DEMAND FOR TENS OF THOUSANDS OF DOLLARS REFUND. They say you are overtreating. They say you are performing unnecessary care in the absence of disease.
You and I well know that just because you can't see caries on a radiograph doesn't mean there was no decay. But the insurance companies can be vicious. There is one thing you can do to help back up your diagnosis, and with today's technology it will take you all of about 10 to 15 seconds (at most). PHOTODOCUMENT CARIES before you remove them! If there is an old restoration, shoot a couple of intraoral photographs after you remove the failed restoration but before you remove the caries. If it's a virgin tooth with caries, then open the tooth up sufficient to visualize the caries, then photo, photo, photo!
I'm fortunate that I've always kept my records this way. Comes from being obsessive compulsive anal retentive! With respect to C&B margins, occlusion and record keeping... turns out that's a good thing!
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