Can Non-Dentists Own Dental Practices?

The question of whether non-dentists may own a part or all of a dental practice is surfacing in at both state legislative levels, at state dental boards, and in the courts, and it is important to note the differences on the issue depending on which state the practice is located in.   One of the key concerns addressed in deciding what policy is used is when does non-dentist ownership interfere with the quality of treatment or treatment decisions which necessarily are made by licensed dentists?

The issue has been a hot one in the courts, with dental management corporations profit motive challenged by dentists and patients because of interference with dentist’s treatment decisions and quality of care. American Dental Partners, a Wakefield, Massachusetts company, was required to pay $130 million in a 2007 Minnesota suit by dentists alleging unlawful corporate decision making in dental practices it owned.   Suits against American Dental Partners have continued in Michigan and California with allegations of withholding of replacement of defective anesthesia equipment, improper refusal of dental services and failure to maintain adequate staffing levels.

Official authorities at the state and federal level have gotten involved as well. The state of Texas has conducted extensive investigations into Medicaid fraud by corporate dental clinics. Since Medicaid is a federal program, testimony before Congressional bodies is part of the resolution of that situation. North Carolina, with backing from the North Carolina Dental Association, has legislation pending which would require state approval of agreements between dentists and management companies.

Many advocates of the companies, however, claim that corporate ownership of practices provides much needed possibilities for positions for new dentist graduates saddled with dental school debt to get a start in the field the help of capital contributed by private non-dentist owners.   They claim that much needed preventive care services and other dental services can be more adequately distributed and made available to the general public with the use of the corporate model. Investigations have focused on whether those positive goals contributing to the rapid growth and popularity of corporations offering such services have also allowed for using profits as determining motives that contribute to problems such as billing for unnecessary services when insurance or federal funds are available to pay for them.

The Massachusetts dental regulations have detailed language concerning just how non-dentists may have an ownership share in dental practices. Any dental practice not wholly owned by licensed dentists must be licensed as a dental clinic, and subject additonally to a more detailed set of regulations applicable within the Department of Public Health’s regulation of health care clinics. Openly marketing dental clinics as dental practices may be considered violations of these rules, since any advertisements for dental services must include the name of at least one owner of the practice who is licensed to practice dentistry. The regulations require the designation of a licensed dentist as a Dental Director in any practice where any dentist practices but does not have an ownership share in the practice.   Dentists are prohibited by the regulations from entering into agreements with any person or entity who does not hold a valid license to practice dentistry which allows that person or entity final decision-making authority over regarding practice decision-making, billing, fees, treatment, supervision, and maintenance of dental equipment and supplies. Detailed licensing requirements and rules having to do with delegation of treatment duties are included in the new 93 page regulations effective as of 2010.

The constant battles over state dental boards’ authorities to decide whether only licensed dentists can perform such treatments as whitening services offered by non-dentist owned and operated companies has also been a part of this non-dentist ownership model issue. The issues are likely to continue to come up as more alternate treatment settings by hygienists or dental therapists with less than full licensure, and without definite supervision by licensed dentists, are allowed by legislatures to promote the expansion of preventive dental care to underserved populations.