Exclusion screening for dental practices and DSOs

Why dental practices are exposed

• Medicaid is the federal payer that matters in dentistry. Original Medicare covers little routine dental care, while state Medicaid programs must cover dental services for enrolled children under 21.
• State lists carry most of your risk. A person excluded by a state Medicaid program can create liability without appearing on the OIG list. Our Beyond the Checkbox report found penalties for missed state-only exclusions grew from about $20,000 to $60,000 in 2020 to $450,000 to $860,000 in recent cases.
• DSOs repeat one gap across every office. When screening runs centrally, a flaw shows up at each location. Beyond the Checkbox describes one compliance failure that spread across 19 nursing facilities under common ownership and cost $1.5 million. A dental group has the same structure.
• Excluded owners put the practice at risk. OIG can penalize an excluded person who keeps an ownership or control interest up to $24,947 per day, and it can exclude the practice itself. That matters when dentists buy in or sell to a DSO.

Who to screen

• Dentists, including associates, part-time dentists, and visiting specialists such as oral surgeons and orthodontists
• Dental hygienists and dental assistants, including temps from staffing services
• Contracted anesthesia providers who sedate patients in your office
• Front desk staff, treatment and insurance coordinators, billers, and coders
• DSO business office, regional, and management staff
• Owners, partners, and investors

The group dental organizations forget most often is the DSO business office. Billing and insurance work often move to a central team that isn’t on any practice’s roster. “Furnished” includes administrative work, so the people who submit your Medicaid claims belong on your list.

“Your dedication and support truly made a difference, and I greatly appreciate all your help.”

Bobby Hale, Sr. Practice Manager, Praxi Management

About 1,000 healthcare organizations trust us with their screening every month, including many dental practices. Exclusion Screening was founded by former federal prosecutors Paul Weidenfeld and Robert Liles.

How we handle dental screening

• Monthly screening of your whole roster against the OIG LEIE, SAM, and all state Medicaid exclusion lists, which matters most for practices whose federal billing runs through Medicaid.
• Identity verification before anything is flagged. We confirm identity with Social Security number, date of birth, NPI, or license data before calling something a match.
• Our specialists resolve matches. When a name comes back, one of our trained specialists works it to a conclusion. Your office manager doesn’t have to research possible hits.
• Dated records for every person, every month, ready when a state Medicaid auditor asks to see your screening history, including for staff who have left.

Plans start at $30 a month for up to 100 people. See pricing or schedule a demo.

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What the rules require of dental practices

OIG’s Civil Monetary Penalties Law. A practice that submits claims to Medicaid or any other federal health care program for items or services furnished by an excluded person is liable if it “knew or should have known” the person was excluded. A screen would have shown it, so not knowing is no defense. “Furnished” covers clinical, support, and administrative work, whether billed separately or bundled.

State Medicaid requirements. In a January 2009 State Medicaid Director letter, CMS recommended that states require providers to screen their employees and contractors for exclusions, including a monthly check of the OIG list. See our overview of state Medicaid exclusion databases and the collateral consequences of a state Medicaid termination.

If a DSO or staffing service misses an excluded person, the penalty still falls on the organization that billed. See why your staffing agency’s screening is not your defense.

What it costs when screening fails

Dental cases are less common than physician cases in OIG’s recent employer settlements, and our Beyond the Checkbox report doesn’t track dental as its own sector. Enforcement against dental providers does happen. We’ve covered OIG exclusion actions involving dental providers, a dental contractor indicted for false claims, and an excluded dentist’s $1.1 million penalty.

The bill has two parts. The civil money penalty can reach $24,947 per claim, and every claim tied to the excluded person’s work is an overpayment that must be repaid.

For a staff member who doesn’t bill directly, OIG’s Self-Disclosure Protocol estimates the overpayment as salary and benefits multiplied by your federal payer mix. Take a dental assistant costing $50,000 a year at a pediatric practice where 70% of patients are on Medicaid: that’s a $35,000 overpayment for each year of employment. For practices that self-disclose, OIG settlements generally start at a 1.5x multiplier on that figure. When the government or a whistleblower finds it first, the False Claims Act allows treble damages, and OIG is not bound by the proxy.

Common dental screening mistakes

1. Assuming no Medicare means no exposure. Medicaid is a federal health care program.
2. Checking only the OIG list. For a Medicaid-heavy practice, the state list matters as much.
3. Screening only licensed staff. Assistants, coordinators, and temps often get nothing after hire.
4. Leaving the DSO office and owners off the roster. Central billing staff work behind every claim, and an excluded owner can put the practice itself at risk of exclusion.

A screening program for a dental practice or DSO

1. Build your rosters. Include clinical and office staff, temps, DSO staff, and owners. Give each office its own roster so it gets its own report. Offices are often audited one at a time.
2. Screen before the first shift. Check the federal lists and the Medicaid list of every state where you bill.
3. Re-screen everyone monthly. Exclusion lists update monthly, so monthly screening is the floor.
4. Resolve every match the same week. Confirm identity, document the outcome, and pull the person from patient care and billing if the match is real.
5. Keep dated records. Store results per person, per month, including people who have left.
6. Have a response plan. See what to do if you have a confirmed exclusion. Dental groups inside larger medical organizations should also see exclusion screening for physician practices.

Questions dental compliance teams ask

We don’t bill Medicare. Do we still need exclusion screening?
If you bill Medicaid, yes. Medicaid is a federal health care program, and OIG’s penalties apply to Medicaid claims for items or services furnished by an excluded person. For dental practices, Medicaid is often the main federal payer, so state Medicaid exclusion lists deserve as much attention as the OIG list.

Do we have to screen dental assistants and front-office staff?
Yes. OIG’s rule covers administrative and support work as well as clinical care. A dental assistant’s chairside work and a coordinator’s insurance verification both sit behind the claims you submit to Medicaid. Screen them before their first day and every month after, on the same schedule as your dentists and hygienists.

Who is responsible in a DSO: the DSO or each practice?
The organization that submits the claim carries the liability. Depending on how your DSO is set up, that may be each practice entity or the DSO. Either way, give each office its own roster and the DSO’s staff their own, screen them monthly, and keep dated records each practice can produce when a state auditor asks.

Which state lists should a dental practice check?
At minimum, the Medicaid list of every state where you bill. Staff who have worked or been licensed in another state can be excluded there without appearing on your state’s list or the federal list. That’s common in practices near a state line. We screen all state Medicaid exclusion lists on every run.

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See SAFER Plus screen a dental roster: every office, every state list, matches resolved by our specialists. Schedule a demo →