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A Pennsylvania dentist was suspicious of a colleague, so he evaluated the colleague's patient records. Two weeks later, the dentist was fired.
A lawsuit in Pennsylvania is raising questions about what role dentists should play in policing colleagues’ practices.
Steven S. Pesis, DDS, who was fired in November from Penn Dental Medicine in Philadelphia, is suing his former employer, alleging he was terminated after he blew the whistle on a colleague that Pesis says was ordering unnecessary procedures.
The University of Pennsylvania, which owns the clinic, said in court filings that Pesis was fired for reviewing a colleague’s patient records without permission. The university told the Philadelphia Inquirer that it would not comment on the case beyond what was in the court filings.
Pesis began working at the clinic in 2012, according to the Inquirer. In November 2015, the practice hired a new dentist. Two days later, Pesis said he began looking at the new dentist’s charts and decided that the new dentist was ordering expensive crowns that were not medically necessarily. Pesis reported his findings to supervisors, and was fired 12 days later.
In its court filing, the university stood behind the new dentist’s work and alleged that Pesis had engaged in unprofessional behavior that violates the practice’s policies as well as the Health Insurance Portability and Accountability Act (HIPAA).
Rules governing intra-office access to dental records vary from state to state and practice to practice. New York State, for instance, says practices should use a “need to know” standard when governing access to records.
“Patient information should be shared only on a need-to-know basis with those who participate in the care of the patient,” the state’s guidelines dictate.
Though Pesis and his former employer disagree on whether this particular dentist was performing too many dental crowns, federal officials believe the issue is a major problem.
In June, US Sen. Charles Grassley (R-IA) sent a letter to the US Attorney General’s Office and the US Department of Health and Human Services seeking information into the extent of fraud among providers of dental care to Medicaid patients.
"Some dentists are clearly performing unwanted and unneeded medical procedures on children without the consent of parents and bilking Medicaid for the privilege," Grassley wrote.