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Regulation and Compliance > Federal Regulation

Texas dentist service firms blast regulation bill

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The Texas Coalition of Dental Support Organizations says its members make dental practices more efficient, by taking over tasks such as marketing, scheduling and billing.

Dentists who don’t use dental service organizations (DSOs) have asked whether the DSOs might not occasionally cross boundaries and interfere with clinical care.

Texas state Sen. Jane Nelson, R-Flower Mound, chairman of the state Senate Health and Human Services Committee, has stepped between the DSOs and advocates of stronger state DSO oversight by introducing S.B. 151, a bill that would define a DSO as being an entity that “is owned wholly or partly by a person who is not a dentist, and, under a dental service agreement, provides or offers to provide services to a dentist or employers or otherwise contracts with a dentist in the dentist’s capacity as a dentist.”

The bill would require DSOs to register with the Texas State Board of Dental Examiners, prohibit DSOs from interfering with dentists’ treatment decisions, change the rules governing dental care for children, and let the dental examiners board punish a DSO that violated the Texas Dental Practices Act.

Texas now has no regulations for DSOs, Nelson said in a statement.

“We need to ensure that these organizations are accountable to the board and, more importantly, that they are not substituting their judgment for that of our trained, licensed dentists,” Nelson said.

Texas lawmakers began talking about DSOs after auditors reported that Texas dental practices, including some served by DSOs, had bilked the state Medicaid program by putting braces in the mouths of poor children who did not need braces.

Dr. Richard Black, a witness who represented the Texas Dental Association — a professional society for dentists –mentioned DSOs at a Medicaid dental benefits hearing convened by the Texas Public Health Committee in November.

“Non-dentist owned entities provide valuable dental services to many citizens in Texas, including Medicaid patients,” Black testified, according to a written version of his remarks posted on the committee website. “These entities have a place in Texas, but they must be held accountable for their activities with dental patients, and the state must have appropriate oversight and resources to properly regulate them.”

Dentists who use DSOs asked in a public letter to the Texas Dental Association why Black had criticized the DSOs.

Some dentists have committed Medicaid fraud, but the problems were caused by bad actors, not by DSOs, the DSO defenders wrote.

The ability to hire DSOs to handle “non-­clinical administrative services enables dentists like us to devote more time to the delivery of high-­quality, cost-­effective dental care to patients,” the pro-DSO dentists said. “In addition, contracting with DSOs enables us to benefit from their economies of scale and bring state-­of-­the-­art technology to our patients and communities.”

Texas already has laws and regulations that officials can use to punish bad actors and prevent DSOs from interfering with dentists’ practices, the pro-DSO dentists said.

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