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What They Didn’t Teach You in Dental School: Billing, Marketing, and Business Venture Compliance

Course Number: 720

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References / Additional Resources

  1. 42 C.F.R. § 455.2 (2025).

  2. Id.

  3. 65 Fed. Reg. 59434 (October 5, 2000) at 59436.

  4. CTRS. FOR MEDICARE & MEDICAID SERVS., U.S. DEP'T. OF HEALTH AND HUMAN SERVS., MEDICARE MANAGED CARE MANUAL, Pub. No. 100-16, ch. 21 (2013)

  5. Id.

  6. 42 C.F.R. § 455.2 (2025).

  7. CTRS. FOR MEDICARE & MEDICAID SERVS., U.S. DEP'T. OF HEALTH AND HUMAN SERVS., MEDICARE MANAGED CARE MANUAL, Pub. No. 100-16, ch. 21 (2013)

  8. U.S. DEP'T. OF HEALTH AND HUMAN SERVS., OFF. OF INSPECTOR GENERAL, A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse

  9. 31 U.S.C. §§ 3729–3733 (2025).

  10. 42 U.S.C. § 1320a-7b(b) (2025).

  11. 42 U.S.C. § 1395nn (2025).

  12. 42 U.S.C. § 1320a-7 (2025).

  13. 42 U.S.C. § 1320a-7a (2025).

  14. 65 Fed. Reg. 59434 (October 5, 2000) at 59449.

  15. United States ex rel. Kramer v. Doyle, No. 1:18-cv-373, at *3-4 (S.D. Ohio Apr. 21, 2022.

  16. PRESS RELEASE, U.S. ATTORNEY’S OFFICE, DISTRICT OF CONNECTICUT, Manchester Dentist, Dental Clinics and Dental Imaging Facility Pay $300K to Settle False Claims Allegations (Updated August 13, 2021)

  17. U.S. DEP'T. OF HEALTH AND HUMAN SERVS., OFF. OF INSPECTOR GENERAL, A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse

  18. PRESS RELEASE, U.S. ATTORNEY’S OFFICE, DISTRICT OF CONNECTICUT, Connecticut Dentist Pleads Guilty to Violating Federal Anti-Kickback Law (September 5, 2024)

  19. See 66 Fed. Reg. 856 (January 4, 2001).

  20. 42 C.F.R. § 411.351 (2025).

  21. CTRS. FOR MEDICARE & MEDICAID SERVS., Article: Oral Appliances for Obstructive Sleep Apnea - Policy Article, A52512 (most recently updated May 9, 2014)

  22. U.S. DEP'T. OF HEALTH AND HUMAN SERVS., OFF. OF INSPECTOR GENERAL, Remington Family Dental and Associates Agreed to Pay $24,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual (May 28, 2014)

  23. U.S. DEP'T. OF HEALTH AND HUMAN SERVS., OFF. OF INSPECTOR GENERAL, Atlanta Dental Agreed to Pay $125,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Dental Services Provided by Non-Credentialed Dentists (February 9, 2018)

  24. 42 U.S.C. § 1320a-7a(a)(1)(B) (2025).

  25. U.S. DEP'T. OF HEALTH AND HUMAN SERVS., OFF. OF INSPECTOR GENERAL, Atlanta Dental Agreed to Pay $125,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Dental Services Provided by Non-Credentialed Dentists (February 9, 2018)

  26. See e.g., N.J. Stat. § 17:33A-1 (2025), et seq.; Cal. Penal Code § 550(a)(1) (2025); N.Y. Penal Law § 177.00 (2025), et seq.

  27. See e.g., Fla. Stat. Ann. § 456.054 (2025); Fla. Stat. Ann. § 817.505 (2025); Mass. Ann. Laws ch. 175H, § 3 (2025).

  28. See e.g., N.J. Stat. § 45:9-22.4 (2025).

  29. PRESS RELEASE, OKLAHOMA ATTORNEY GENERAL’S OFFICE, Broken Arrow dentist to pay more than $500,000 after False Claims Act allegations (July 31, 2025)

  30. See e.g., Mo. Rev. Stat. § 332.321(18) (2025); 22 Tex. Admin. Code § 108.53(b) (2025)

  31. AMERICAN DENTAL ASSOCIATION, Principles of Ethics & Code of Professional Conduct (Oct. 2024), Sec. 4.E

  32. Nev. State Bd. of Dental Examiners v. Lajevic, No. A-14-704250-C (Dist. Ct. Clark Co., N.V. Sept. 17, 2014).

  33. Sachs v. Saloshin, 526 N.Y.S.2d 168, 169-70 (App. Div. 1988).

  34. OCA, Inc. v. Hassel, 389 B.R. 469, 476 (E.D. La. 2008).

  35. Id.

  36. State v. Boren, 36 Wash. 2d 522, 528, 219 P.2d 566, 570 (1950).

  37. PRESS RELEASE, NEW YORK STATE ATTORNEY GENERAL, A.G. Schneiderman Announces Settlement With Aspen Dental Management That Bars Company From Making Decisions About Patient Care In New York Clinics (June 18, 2015)

  38. N.J. Stat. § 46:30B-42 (2025).

  39. See e.g., N.J. Stat. § 46:30B-42 (2025), et seq.

  40. 65 Fed. Reg. 59434 (October 5, 2000) at 59439.

  41. Id.

  42. PRESS RELEASE, U.S. ATTORNEY’S OFFICE, DISTRICT OF SOUTHERN DISTRICT OF WEST VIRGINIA, Charleston dentist sentenced to five years in federal prison for health care fraud (December 7, 2017)

  43. AMERICAN DENTAL ASSOCIATION, Principles of Ethics & Code of Professional Conduct (Oct. 2024), Sec. 5.B.1

  44. Id.

  45. Feiler v. N.J. Dental Asso., 191 N.J. Super. 426, 467 A.2d 276 (Super. Ct. 1983); Oxford Health Ins., Inc. v. Josephson, 2010 NY Slip Op 32014(U), ¶ 14 (Sup. Ct. 2010).

  46. See Am. Fedn. of State v. Bristol-Myers Squibb Co., 948 F.Supp.2d 338, 350 (S.D.N.Y.2013).

  47. See 42 U.S.C. § 17935(a)(2) (2025).

  48. N.J.A.C. 13:30-6.2(n) (2025).

  49. Commonw. Of Pa, Bureau of Prof’l and Occup. Aff. v. Valik, Docket No. 0917-46-01, File No. 01-46-00150 (Dec. 4, 2007).

  50. N.J.A.C. 13:30-6.2(n) (2025).

  51. AMERICAN DENTAL ASSOCIATION, Relationships with Third-Party Payers

  52. 47 U.S.C. § 227 (2025)

  53. See 47 C.F.R. § 64.1200(f)(9) (2025).

  54. Charvat v. Ryan, 116 Ohio St. 3d 394 (2007).

  55. 15 U.S.C. § 7702(2)(A) (2025).

  56. See 15 U.S.C. § 7704 (2025).

  57. See e.g., Conn. Gen. Stat. § 42-288a (2025); N.J. Stat. § 2A:65D-2 (2025).

  58. See e.g., D.C. Code Mun. Regs. tit. 17 4216.2 (2025); N.H.Rev.Stat.Ann. 317-A:17(II)(h) (2025); Md. Code Regs. 10.44.06.02 (2025).

  59. PRESS RELEASE, FEDERAL TRADE COMMISSION, Dental Practice Software Provider Settles FTC Charges It Misled Customers About Encryption of Patient Data (January 5, 2016)

  60. PRESS RELEASE, OFFICE OF THE MASSACHUSSETS ATTORNEY GENERAL, Attorney General’s Office Reaches $3.5 Million Settlement With Aspen Dental Over Claims of Deceptive Advertising (January 5, 2013)

  61. See e.g., Md. Code Regs. 10.44.06.02(11) (2025).

  62. In Re: Dr. Gary R. Dornfeld, Uniform Penalty Letter In Lieu of Formal Disciplinary Complaint, Advertising Complaint No. 51632, New Jersey State Board of Dentistry (May 12, 2008).

  63. 65 Fed. Reg. 59434 (October 5, 2000) at 59435.

  64. Id.

  65. Id.

  66. See e.g., 45 CFR 164.530(b) (mandating workforce training on the Health Insurance Portability and Accountability Act of 1996); 29 CFR 1910.1030(g)(2) (mandating employee training regarding bloodborne pathogen requirements under Occupational Safety and Health Act of 1970); Cal. Gov. Code § 12950.1(a) (requiring covered employers to provide sexual harassment and abusive conduct training to supervisory and nonsupervisory employees).

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