A friend is a dentist who has a large geriatric practice with nursing home patients throughout Chester
County. The dentist typically visited the residents and conducted routine dental examinations in an office specifically set up by the nursing home. As part of the routine exam and without the request of an attending physician or because of any medical concern, the dentist would also conduct an oral cancer screening. The dentist would then bill Medicare for both the routine dental exam and the oral cancer screening.
In his own mind, the dentist never knowingly presented a false claim to be reimbursed by Medicare. But, he also deliberately never researched any of the laws or regulations to determine if conducting the additional oral screening was within a routine exam description. He openly bragged to his colleagues at the latest dental conference in Las Vegas that he also did not care whether he was breaking any law because he had not been caught yet and the pay was generous from Medicare and TRICARE. He bragged that if he "didn't know it was wrong, it could not be breaking the law" and he was not going to take any additional measures to find out.
You recently became aware of your friend's actions because your loved one is a resident at one of the homes where the dentist's visits.
What advice would you give to the dentist?
First, write out the name of the rule and the rule language (from the text Introduction to Health Care Management
by Buchbinder, Sharon Bell Shanks, Nancy H.) that guides your advice.
Next provide your advice in full with support from the rule that you have written. Write out the name of the rule and the rule language that governs your response.
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