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Speculation on dental fraud in perspective

DATE: 24.06.2011

 

2009 was a year of cuts and controversy for dental practitioners nationwide. Speculation arose over fraudulent claims, allegedly costing the State nearly €8m, while the 2010 Budget marked the end of an era for free or partially free dental treatment funded by the State.

The State effectively set a deadline of March 2010 for patients to avail of subsidised treatment which has led to a surge in scheduled appointments nationally for the first 3 months of 2010.

It has been reported in the National Press[1] that this led to a number of clinics sending in advance of the deadline, lists of hundreds of patients to the Department of Social Welfare seeking clarification as to whether customers were eligible for treatment benefit under the scheme. Controversy arose as spot checks revealed that some of these patients had actually passed away, while several forms were signed with the same signature. A number of patients were contacted, who revealed that they had not approached the dentist to seek treatment, nor had they authorised the dental practice to submit an application on their behalf. 

A spokesperson for the Irish Dental Association (“IDA”), Fintan Hourihan, urged dental practitioners nationwide to provide accurate and factual information to the Department of Social Welfare. However, he blamed the incorrect applications on the short period given to wind up the scheme. It was acknowledged that some of these forms may have been erroneously signed in the frantic rush period.

The Dental Treatment Services Scheme (“DTSS”), a free dental scheme available to adult medical card holders, came under scrutiny due to the significant extra demand placed on it during the past year. The DTSS budget was restricted to 2008 levels, despite an expected increase in demand for services. The HSE reported that the scheme provided 30 per cent more treatments than projected, up to August 2009. As the HSE reimbursed dentists on a fee-for-service basis, criticism arose due to allegedly inappropriate and exaggerated claims under the DTSS for reimbursement by practitioners.

Figures showed that 3 per cent of all claims for reimbursement by practitioners under this scheme were not paid during the period January – August 2009. This sparked speculation that these were ‘inappropriate claims’. However, it would appear that claims are not paid when they fail to meet the necessary criteria for a valid claim. This can also arise due to forms being unsigned or filled out incorrectly.

The IDA has commented that speculation regarding fraudulent claims is grossly unfair, especially when the probity scheme, which had been in place with the full support of dentists and the IDA, was withdrawn by the HSE for no apparent reason in 2007. In a recent report commissioned by the HSE it was confirmed that the current levels of probity assessment are very weak. There is considerable opportunity for bad practice and manipulation of the schemes where no checks are in place. A comprehensive probity scheme would ensure that all dentists operate under the same rules. It would also ensure that treatments occur with appropriate quality and care and would offer dentists a meaningful defence against accusations of fraudulent claims. It has the support of all branches of the IDA.

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[1] Irish Times, 22 December 2009,  by Elaine Edwards

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