The Department of Health recently sent letters to approximately 1,000 dentists nationally, in relation to claims under the Child Dental Benefits Schedule (CDBS).
Should you receive one of these letters it is important that you do not action it without first consulting your local ADA branch, or Guild if you are not a member of the ADA. At this stage the Department appears to have requested responses by 7 February 2019, so there is no immediate urgency to respond.
Guild is working closely with your ADA Branches and Meridian lawyers to understand what the possible implications of the letters are and to determine the most appropriate strategy to deal with them. Between us, we have a strong history and vast experience with similar inquiries in the past, including the Department’s 2011 audit of claims made by dentists under the Chronic Dental Disease Scheme (CDDS)
If you have already, or do receive a letter from the Department, Guild’s strong advice is that you;
- Do not respond to the letter at this time, and under no circumstances should you complete the Voluntary Acknowledgement of Incorrect Payments form.
- Do not write on or otherwise mark the schedule of services, which will be annexed to the letter (this will become an important working document and from our experience, the Department will not issue a “clean” copy).
- Immediately contact your local ADA branch to report the matter. They will request a copy of the Department’s letter and, with your permission, log a notification with Guild.
- If you are not a member, please telephone Guild directly on 1800 810 213 to report the matter.
Guild, our ADA partners and Meridian Lawyers are committed to developing a strategy that is simple and consistent (regardless of which state you practice in or which ADA branch you are a member of), which will minimise the impact on individual members involved and to the scheme as a whole.
Frequently Asked Questions
Q. Why do you recommend against completing the voluntary acknowledgement?
A. In our experience, any response to the acknowledgment is likely to lead to a request for records to support the amounts claimed. While couched as a “voluntary acknowledgment”, the document is a declaration, which may have legal or disciplinary ramifications.
Q. What could happen if I complete the declaration?
A. We anticipate from past experience that by completing the declaration, and answering that the services listed on the Schedule meet all of the requirements, the Department will then ask for copies of your dental records to support the claims for them to audit. If the Department then disagree with your declaration, their response could range from the lower end of seeking a refund and adding a 20% penalty loading, to the higher end of referring the matter to the relevant regulator for investigation and possible disciplinary action.
Q. Will I have to pay back amounts claimed to the Department?
A. It’s possible in some circumstances that we will recommend you offer to do this at an early stage. In some cases, you will have compliant records and a valid explanation for why your claiming “profile” is higher than your peers. In those instances, we will assist you with making appropriate representations to try and avoid a payback. However, we know from past experience that if your records do not meet the necessary standard to support the necessity of the treatment, then such an offer may avoid the necessity to repay the amount plus a penalty.
Q. What are Guild and the ADA state branches doing to ensure that the Departments’ interpretation is correct?
A. We are working ensure that representations made by the Department about the application of requirements are accurate and properly represent the Dental Board’s requirements (particularly in relation to record keeping) and our own understanding of the CDBS rules. Where we believe they are incorrect, we will make appropriate representations to them and where possible negotiate a sensible and pragmatic interpretation for the sake of consistency.
Q. Who will help me with my matter?
A. This will depend on the nature of the correspondence you receive and your individual circumstances. In most cases we expect you will be assisted in your individual case by peers from within your state ADA branch, supported by Guild Liability specialists. This will be supported by overarching legal support from Meridian Lawyers on our strategy and approach. In certain circumstances Meridian will be directly involved, but we are committed to ensuring they are only engaged where absolutely necessary to minimise the potential impact on your individual premium and premiums overall under the ADA/Guild scheme.
