Estimated reading time: 5 minutes
When faced with regulatory complaints and audits, many dentists turn to Dr Martin Webb for help. By Tracey Porter
No dentist ever expects a patient to pass away after booking in for a simple tooth extraction. Likewise, few oral health professionals anticipate a patient will suffer a bowel perforation having swallowed the dental impression material while having a crown made.
While rare, these worst-case scenarios can and do occur and can result in a wide range of professional repercussions for a dentist, including an investigation by the Australian Health Practitioner Regulation Agency (Ahpra).
When things do go wrong, it often falls to Queensland dentist and Ahpra auditor, mentor, and educator, Dr Martin Webb, to help a dentist and their practice navigate the complex world of professional standards and personal indemnity (PI) claims.
Dr Webb’s work in this area began nearly two decades ago when he was chair of a third-party liaison committee for the Queensland branch of the Australian Dental Association (ADA). As part of that role he was often required to assist members with managing health fund audits.
“Part of this was trying to find the balance between what the health fund believed was reasonable use of ADA item numbers, and what the dentist wanted to claim for their patients,” he says. “Sadly, what we often saw was creative use of item numbers by a small proportion of dentists, accompanied by clinical records that were often very sparse or non-existent.”
He was then approached to help dentists who were subject to legal claims against their PI insurance policies. This in turn led to him fielding requests from a number of dentists requiring help with finding an auditor to satisfy the Ahpra audit conditions of their registration.
Roughly four per cent of registered dentists will receive a notification from a patient each year, according to data in the 2023/24 Ahpra Annual Report. The report confirms that 1058 dental practitioners in Australia attracted notifications for issues ranging from behaviour and billing to infection and informed consent. Fewer than nine per cent of all notifications resulted in conditions being imposed on their Ahpra registration.
Dr Webb notes he is currently helping seven dentists comply with the education and audit requirements of such conditions.
When assisting dentists with health fund audits, Dr Webb claims the main problem is the quality of kept dental records; it is not uncommon to see the item number but no written entry under that item number. For a health fund auditing these records, it is difficult to verify the treatment occurred as claimed. “Some dental practitioners can be remarkably creative in their billing of patients,” he states.
I have seen many dentists being audited by health funds who routinely use 7-to-10 item numbers for a similar standard recall appointment. What this does is raise the servicing profile of that dentist, so they are more likely to be the subject of an audit.
Dr Martin Webb
“For a standard check-up and clean appointment, I would typically bill the patient for an 012 and a 114. I have seen many dentists being audited by health funds who routinely use 7-to-10 item numbers for a similar standard recall appointment. What this does is raise the servicing profile of that dentist, so they are more likely to be the subject of an audit. Many dentists who are the subject of an audit by a health fund are what is known as ‘the outliers’, which means their billing of that item number is a lot higher when compared to their peers.”
Restrictions on your registration can be a costly business, says Dr Webb. Simple cases may only involve a few hours of additional education, which can cost the dentist between $2000 and $3000, depending on the complexity of the reports required.
Other cases can involve several senior dentists, specialists and multiple educators to assist the dentist with conditions of supervision and auditing. These types of restrictions can be in place for over 12 months, costing the dentist over $30,000 personally because they are often not covered by their PI insurance.
Dr Webb says it is crucial dentists keep good clinical records. There are good resources to help them with this including the Dental Board of Australia’s self-reflective tool and Fact Sheet, Ahpra’s ‘Managing health records’ webpage, Ahpra’s and the National Boards’ codes of conduct, and the ADA guidelines on record keeping.
Accurate clinical records can also serve as a defence against a claim of negligence or misconduct. In addition, they are required by third parties such as Medicare and health funds to confirm claims.
Once notified by Ahpra of a patient complaint, Dr Webb advises dentists to reflect on what drove the patient to complain to the regulator in the first place. While many dentists get defensive when faced with an investigation, a better response is to demonstrate professional insight. “Often a good idea is to proactively undertake continuing professional development programs that relate to the issue raised by the patient,” he adds. “So, if they complained about a poor outcome from a failed RCT treatment, then you enrol in a six-hour course in endodontics to improve your training and skills in that area.”
The next step is to get help. There are experienced teams in most ADA state branches who can assist members to issue a response to Ahpra. In some cases, PI insurers can help as they also have staff experienced in managing these situations.
Dr Webb argues one of the best ways to ensure a complaint doesn’t lead to an Ahpra investigation is to have an effective internal complaints management policy and process within your practice.
In some cases, all the patient wants is an apology and a refund of treatment costs. Showing empathy to the complainant and dealing with their concerns professionally and courteously cannot be underestimated, he says.
“You are much better off to reach into your pocket and refund the patient than to have to pay out over $30,000 for a complex Ahpra investigation that may result in serious restrictions on your registration.”
