
Dr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net
Unlicensed Dental Hygiene Practice as a Business Model
The unlicensed practice of dental hygiene is unlawful in all 50 states. In reality, enforcement is lax to nonexistent. In the infrequent event of violators charged, the bigger the violator, the more lenient the penalty. State regulatory dental boards have generally failed to address this problem, and their inaction has enabled and emboldened violators. Dental practices which conduct their business affairs within the rule of law are at a distinct marketplace disadvantage, to dental practices which engage unlawful dental hygiene practice as a business model.
Traditionally, only doctors were lawfully permitted to own dental practices and supervise the practice of dental hygiene within their businesses. Today, a dental practice may only be “owned” by a dentist(s) as a nominee figurehead. An outside corporation may truly beneficially own and manage the dental practice and the practice of dental hygienists. These beneficial owners (often private equity investment companies) pull the strings on the doctor/patient relationship, as well as the practice of dental hygiene in their clinics via dental service organizations (DSOs).
Jesus Villegas, DDS MS
Dr. Villeges, a pediatric dental specialist with clinics in Milford and West Haven, CT, settled with the US government for $1.3 million for his alleged actions of utilization of uncertified dental assistants in taking dental radiographs.1 These patient services could only lawfully be delegated to certified dental assistants or licensed dental hygienists. This dental Medicaid fraud case was notably prosecuted in Connecticut, as were earlier federal and state criminal actions against Dr. Gary Anusavice2 and later Dr. Mehran Zamani3, who operated a chain of dental Medicaid clinics, also in CT.
Phillip M. Coyne, Special Agent in Charge with the US Health and Human Services- Office Inspector General stated, “Dentists must ensure that only certified staff provide services to their patients. Cutting corners could jeopardize the safety of patients and the integrity of the Medicaid program. Working with our law enforcement partners, our agency is dedicated to protecting patients and the government health care programs designed to serve them.”1
US Attorney Deirdre M. Daly added, “Health care providers must utilize properly certified individuals to treat patients, and the failure to ensure such proper care for patients will have serious consequences.”1
Douglas Macko, DMD MS
In the case of State of Connecticut versus Douglas Macko, the decision awarded $717,000 to the plaintiff, for Dr. Macko’s violations to the Connecticut Unfair Trade Practices Act.4 Dr. Macko unlawfully employed unlicensed personnel to provided dental hygiene patient services to pediatric dental patients. The court’s decision went into length on Dr. Macko’s efforts misrepresent facts of the case. The court also determined unlicensed staff falsified statements of fact in affidavits to support their employer. Like the aforementioned legal case of Dr. Jesus Villegas, this legal action involved a specialist pediatric dentist, and primarily dental Medicaid fraud.
Thomas P. Floyd, DMD MS
Similar to the previous cases, Dr. Floyd was a pediatric dental specialist mostly serving a children’s Medicaid population. However, his case was prosecuted in Florida, not Connecticut. In Florida, dentist violators are far more likely to receive regulatory wrist-slaps and large chain DSOs no investigation whatsoever (similar to most states).