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Insurance Audits, Board Investigations and Criminal Matters

by PracticeCFO | December 22, 2023

What are the most common legal issues a dental practice might face? 

How can dentists protect themselves from insurance audits? Board investigations? Or criminal charges?

Justin Withrow is Partner at Flannery Georgalis, LLC, where he specializes in representing dentists in regulatory investigations, insurance audits, professional licensing matters and complex business litigation.

Matt Odgers serves as Dental Attorney at Odgers Law Group, a firm with expertise in representing buyers and sellers in the purchase or sale of a dental practice.

On this episode of The Dental Board Room, Justin and Matt join host Wes Read to explain how a dental practice should approach sensitive legal matters.

Justin describes how a practice gets selected for an insurance audit, challenging dentists to put systems in place and conduct internal compliance checks to prepare for such an audit.

Matt and Wes ask what triggers a state board investigation, and Justin offers advice on reaching out to malpractice and securing legal counsel for your dental practice.

Listen in for insight on why a practice might find itself under criminal investigation and learn how the right attorney can help you navigate these challenging legal matters.

Topics Covered 

[1:56] Justin’s background representing dentists with sensitive legal matters

[4:54] How a dental practice gets selected for an insurance audit

[8:03] Examples of statistical outliers that might trigger an insurance audit

[10:44] Variations in provider agreements among private insurance companies

[12:14] How often private insurance companies turn over the findings of an audit to a state board for criminal action

[13:41] 4 potential outcomes of an insurance audit and why it’s crucial to respect the process and respond in a timely manner

[18:52] The typical terms built into a contract between an insurer and provider (and how to terminate such an agreement)

[21:08] Building systems into your dental practice to prepare for an insurance audit

[22:39] How to properly document services provided and withstand the scrutiny of an insurance audit

[24:51] The benefit of having Justin’s firm conduct a compliance check for your practice

[27:20] What triggers a state board investigation of a dental practice

[30:03] Why a practice should take a state board investigation seriously from Day One

[35:05] When Justin suggests reaching out to your malpractice provider

[38:45] The quality of legal advice from on-panel providers for an insurance company

[42:20] Justin’s advice on how to secure legal counsel for a board investigation

[43:59] What partner dentists in a DSO can do to protect themselves from a board investigation

[47:16] Why a dental practice might find itself under criminal investigation

[51:35] The challenge of rebuilding a practice after a search warrant is executed

[53:17] Why Justin suggests consulting a lawyer before you answer any questions in a criminal investigation

[56:01] Case studies of 2 dentists Justin represented in criminal investigations


Connect with Justin Withrow 

Justin on LinkedIn

Flannery Georgalis

Connect with Matt Odgers

Matt on LinkedIn

Odgers Law Group

Resources

Dentist, Dental Practice and DSO Representation at Flannery Georgalis

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