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C. RICHARD MILLER v. COMMONWEALTH PENNSYLVANIA (01/11/79)

decided: January 11, 1979.

C. RICHARD MILLER, D.D.S., THOMAS R. SNELL, D.D.S., CHARLES M. HUGHES, D.D.S., DANIEL K. LOVETTE, D.D.S., PETITIONERS
v.
COMMONWEALTH OF PENNSYLVANIA, STATE DENTAL COUNCIL AND EXAMINING BOARD, RESPONDENT



Appeal from the Order of the State Dental Council and Examining Board in case of In the Matter of the Suspension or Revocation of the following licenses: License No. 8710 Issued August 8, 1932 to Richard Miller; License No. 17031 Issued August 28, 1950 to Thomas Snell; License No. 96233 Issued August 10, 1936 to Charles Hughes; License No. 13304 Issued August 29, 1955 to Daniel Lovett; License No. 13696 Issued July 29, 1957 to Carl Brothers.

COUNSEL

David A. Wion, with him James W. Reynolds, and Reynolds, Bihl and Schaffner, for petitioners.

William Wheeler, Assistant Attorney General, with him Louis B. Rubin, Assistant Attorney General, and Robert P. Kane, Attorney General, for respondent.

Judges Blatt, DiSalle and MacPhail, sitting as a panel of three. Opinion by Judge MacPhail. Concurring and Dissenting Opinion by Judge Blatt.

Author: Macphail

[ 39 Pa. Commw. Page 615]

Appellants, all of whom are oral surgeons licensed by the State Dental Council and Examining Board (Council) to practice dentistry in Pennsylvania, appeal from an adjudication and order of the Council which suspended their licenses to practice*fn1 because of alleged violations of Section 3(i) of The Dental Law (Law), Act of May 1, 1933, P.L. 216, as amended, 63 P.S. ยง 122.*fn2 The Council took its action after four days of extensive hearings. Its adjudication includes 114 separate findings of fact. It is quite obvious to us that this case received the very careful consideration it deserved and that the Council acted only after deliberating at length.

[ 39 Pa. Commw. Page 616]

During the period from 1969 through 1971, all of the Appellants practiced oral surgery in the Miller Clinic (Clinic) which was a sole proprietorship operated and supervised by the Appellant, Miller. An investigation and review conducted by representatives of Pennsylvania Blue Shield of those persons or institutions receiving more than $10,000.00 in payment for oral surgery services for any specific year revealed numerous discrepancies at the Miller Clinic. These discrepancies were reported to the Council whereupon citations were issued to each of the Appellants charging them with violating Section 3(i) of the Law. Specifically, Miller, as the chief administrative and supervising dentist, and each of the Appellants as the actual perpetrators were cited for filing false claim reports with Pennsylvania Blue Shield. The Council found that such false claim reports had been filed and concluded that that practice violated that portion of Section 3(i) of the Law which prohibits fraudulent or unlawful practices or fraudulent misleading or deceptive representations and unprofessional conduct detrimental to the public health, safety, morals or welfare.

From the record it appears that the Clinic operated mostly on referrals from other dentists. When a patient appeared at the Clinic for the first time, a patient chart form was completed and a panorex x-ray was taken. The patient was then seen by one of the surgeons at the Clinic and the type of work to be done was determined. For each patient the record of treatment was recorded on the patient's chart by the surgeon performing the treatment. The surgeon who performed the surgery was responsible for listing the exact operative procedure on the patient's chart. Surgery was performed either at the Clinic or at a nearby hospital. Patient charts and cards went with the patient at all times. At the end of the day the patient's

[ 39 Pa. Commw. Page 617]

    charts were taken to the business office located in the basement of the Clinic and there all information was transferred by a secretary from the patient's dental charts to a charge card or insurance form. Insurance forms submitted to Pennsylvania Blue Shield were stamped with the teating surgeon's signature. Each of the surgeons had executed an authorization agreement accepting full responsibility for all statements, representations and certifications appearing on claims submitted to Pennsylvania Blue Shield to which his signature stamp had been affixed. Occasionally, the treating surgeon would send a personal note of appreciation to the forwarding dentist. Such notes bore the handwritten signature of the treating surgeon. The Appellant, Miller, "ran" the Clinic and was its sole administrative supervisor. The records of the Miller Clinic for the years which were the subject of the investigation were destroyed by a flood.

Blue Shield Medical/Surgical Agreements in effect for the period in question excluded coverage for oral surgical services related to the care or extraction of teeth other than fully or partially impacted teeth. Appellants were cited for submitting claims to Blue Shield for the removal of impacted teeth when, in fact, the Council found that the x-rays and other documents available to them indicated that the teeth extracted were not impacted. Appellant Snell was cited for four such cases, Hughes for two, and Lovette for six. At the time of the hearing an exhibit was submitted to the Council indicating that more than a hundred such discrepancies had been documented and that the specific cases submitted to the ...


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