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• Claiming errors


“READY TO WALK THE REPAYMENT MAZE?”


SoundBite editor Doug Hamilton offers advice on the complex world of NHS claiming regulations


T


HE treatments offered by our wonderful NHS are many and varied. In most instances care is also free at the point of delivery. One notable exception is NHS dentistry where patients – unless from an exempt group – are presented with an invoice at some stage in their treatment (often leading to hilarious quips about needing more anaesthetic). The business and the practice of dentistry are not easy bedfellows.


Most dentists are motivated by a desire to help patients, rather than ask them for money. However, where a service has been successfully provided, a fee must be paid or funding for future care delivery will dry up.


Resolving disputes Of course not all treatments proceed as planned. Where something has gone wrong (particularly if this was not anticipated and explained at the consenting stage) then an opening offer of reimbursement or a free remake is often appropriate. Many (although not all) disputes are resolved in this manner. Where there has been an adverse outcome, compensation over and


above the cost of the original treatment may be demanded. Even when the treatment appears to have gone as planned, the patient may look for money simply because their expectations (often in terms of aesthetics) have not been met. Some members, having sought advice from MDDUS, will stand their


ground but many fear the matter could escalate as far as a referral to the General Dental Council – even for baseless complaints. In these situations, working for a salary without reliance on income


from patients can look very attractive. Yet, the self-employed status of most GDPs does offer a degree of opportunity and autonomy. Whilst some opt to work part-time, others work intensively and over long hours in the knowledge that an enhanced salary can be earned. Clearly, this work rate must not negatively impact clinical standards. Furthermore, within the NHS there are also a significant number of rules


restricting the fees that can be claimed by even the most industrious dentist. These provisos are buried in somewhat opaquely drafted NHS regulations, but failing to comply can have serious consequences.


Detecting errors A number of agencies are tasked with protecting the public purse. In relation to dental payments, this may involve the sampling of records, identification of ‘outliers’ and statistical analysis. If they find the rules have been broken, however inadvertently, the relevant fees may be recovered. For associates, it does not matter whether a percentage has already been paid by them to the practice owner. For principals, it does not matter whether a significant proportion of the fees has been expended on laboratory bills, wages, materials etc. It does not matter that both principals and associates may have already paid tax on these earnings. The relevant agencies invariably expect to recover the entire fee. We have found that, in Scotland, superannuation and the GDPA allowance may be added on a pro rata basis. The sums involved in each misclaim may be pretty trivial but


practitioners tend to unknowingly repeat the same error year after year. Once the problem has been detected, the results tend to be extrapolated


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