Attendance: Bloom, Chustckie, Engel, Glickman, Huberman, Kline, Krantz, Leizer, Schambra, Silverstein, Weiner
Acceptance of Minutes –1/11/00-vote unanimous.
President’s Report-M. Schambra
• The ADA is accepting nominations for awards for three programs, The Geriatric Oral Health Care Award, the Community Preventative Dentistry Award, and the Access Recognition Award. These awards would be given to organizations that have implemented such programs.
• NJDA and Art Meisel are accepting nominations for the Sy Symanski Lifetime Achievement Award. The award was first given at the Annual Session in June 1997 to Sy Symanski for more than 50 years of service. Nominees should be member dentists who are life members of the NJDA and ADA and have demonstrated outstanding service to the Association, the profession, and the community. A list of life members is available to consider possible candidates. A committee will explore potential nominees.
• Marlene Glickman begins working today. Her duties will be recording and submitting the minutes for the newsletter to the editors, preparing new member and life member certificates, and monitoring the MCDS telephone. She will meet with Dr. Bloom to discuss protocol for inquiries, referrals, etc. These duties can be expanded and modified over time as deemed appropriate by the Board.
President-Elect’s Report-C. Bloom
The slate of nominees was published in the last newsletter and will be voted on at next week’s general meeting.
Editor Reports
R. Kline-Business Editor-Paychex will be a new full-year advertiser for the newsletter. They have also reserved a sponsor table for the February meeting.
NJDA Trustees Report-D. Krantz
• The Board voted to comment on the draft PIP regulations that the time period for filing claims under PIP should be from the point of discovery of the condition rather then 30-day period currently contained in the proposed regulation.
• A presentation was made on a new oral cancer detection tool, Oral CDx (Computer Assisted Diagnosis). Samples of the testing package were distributed and a videotape demonstrating sampling techniques was shown.
• Art Meisel is suing Princeton Insurance Company for denial of business interruption claims due to Hurricane Floyd. The policy covers loss of income if your practice is interrupted due to loss of utility service, among other things. The policy does not cover flood damage, so they denied the claims based on the fact that the water treatment facility was flood damaged and not providing water service.
• A resolution will be presented to NJDA/ADA regarding the National Practitioner Data Bank for there to be a limit to the length of time a practitioners name is kept on record after an incident is reported.
NJDA Council Reports:
Annual Session-P. Engel
• Jane Wyckham announced her resignation from NJDA. She was the Events Coordinator for over ten years. She will be greatly missed.
• There will be a 40% reduction in course tuition for New Dentists this year. This is in lieu of the council sponsoring their own course.
• Childcare will be made available this year for dentists coming to the Session with their families.
• Companion tickets will be available for many courses this year so that members may bring their spouse or guest.
• The Council is investigating having a combined meeting with the hygiene association.
• Last year, exhibitors were disappointed in the turnout in the exhibit hall. This year, to increase traffic through the exhibit hall, registration, boxed lunches, the wine and cheese party and other special functions will be held there. The course hours will also be adjusted to make it easier to visit with the sponsors.
New Dentists-M. Weiner
See full report in newsletter.
Peer Review-J. Fahsbender
A case was heard on appeal by the patient from another component. Middlesex County reviewed the case and upheld the original ruling in favor of the dentist.
MCDS Committee Reports:
Mentor-E. Glickman
• The State Board approved the Periochip course for 2 CE credits. Another seminar will be held in the spring.
• Another OSHA course will be offered (date TBD).
Corporate Sponsorship-J. Chustckie
Three sponsor tables are booked for the next two general membership meetings.
Continuing Education-J. Chustckie
The committee is discussing bring in Dr. Paul Belvidere to lecture on cosmetic dentistry. It will be a Wednesday course in September or October. Kerr and Premier will be two major sponsors for this course at the rate of $2500/each. Benco will provide other sponsors.
Old Business
Another ADA spokesperson trainer seminar is scheduled. Contact Lynn Foley at NJDA if you are interested.
There will be a vote on the revisions to the bylaws that were printed in the January newsletter.
New Business
A motion was made for MCDS to pay for the tickets for the President’s Dinner at the Annual Session for our state trustee, President, and President-Elect and their guests. Vote 8-yes, 1-no, 1-abstain.
Respectfully submitted,
Bruce A. Huberman, DMD
Secretary

• State- As a special member benefit, NJDA is sponsoring a 5 hour CE course on Wednesday, April 5, 2000 (9:30AM-3:30PM) at the Hasbrouck Heights Hilton in Hasbrouck Heights featuring Dr. Dale Miles on Digital Radiography for a cost of $35. All members should take advantage of this opportunity for low cost CE.
• Component- Although the ADA increased its dues by $13 for the year 2000, Middlesex County Dental Society, thanks to continued fiscal restraint and savings, was able to reduce its dues by $13 as an offset, thus giving our membership no net dues increase!

• A resolution allowing advertising in the Capsule was discussed. The resolution provided for inclusion of an advertising insert in the Capsule as well as display advertising on the back page of the newsletter. The Board approved the development of a comprehensive advertising package to include the Journal, Capsule, Annual Session Program Guide, Membership Directory, Annual Session Exhibition and CE Courses.
• Counsel and Executive Director Arthur Meisel reported that the PIP appeal and the Princeton Insurance lawsuit on behalf of our member dentists were proceeding.
• President-Elect Dr. Riva reported that meetings were held with Congressman Franks and Senator John Corzine to discuss organized
dentistry’s positions on pending legislation.
* The Board will recommend to the House various changes to the bylaws including allowing the President and President-Elect of the Association to serve respectively, at least as Delegate and Alternate Delegate from their components during the period in which he or she serves as President or President-Elect.

•MCDS reduced our dues portion $13 to make up for the $13 dues increase this year by the ADA, therefore giving their members no net dues increase for 2000. A combination of non-dues income (corporate sponsorship/advertising), savings from printing the newsletter in-house, and continued fiscal restraint by the MCDS Board has enabled us to provide our members with this benefit.

•Voluntary contributions from NJDA Members are strongly encouraged to support NJDA’s sponsorship of the Special Olympics. This is a worthwhile cause that is also providing member dentists with a targeted PR marketing campaign.

•MBNA has a credit card endorsed by NJDA that provides royalties (non-dues income) to NJDA based on usage.

The Council on New Dentists traditionally sponsors one reduced fee course at the NJDA Annual Session to encourage attendance by dentists out of school 10 years or less. Due to the efforts of the Council working with the Council on the Annual Session, new dentists may now select any course of their liking for the reduced fee during the May 19-21 NJDA Annual Session,
Recently renamed the Mid-Atlantic Dental Expo.
In addition, the Council, in the best interests of encouraging new membership, proposed to the NJDA officers and Board that dues discounts be granted for husband/wife dentists and part-time dentists; and that state and component dues structures be amended so that new dentists do not pay full dues until their fifth full year out of dental school. At this time, it is uncertain if NJDA’s present budget will accommodate these membership incentives for the year 2001, but the feasibility is currently being explored.

Last week I saw an advertisement recommending that people report their doctors for fraudulent insurance practices. There was a telephone number supplied which connected with a newly created New Jersey State agency, specifically created to solicit complaints, investigate these complaints, and punish the offenders.
Fraud is defined by Webster’s Collegiate Dictionary (Tenth ed.) as the intentional perversion of truth in order to induce another to part with something of value or to surrender a legal right. To my thinking, there are three types of fraud related to dental insurance. First, there is fraud by a patient or private individual who files a false claim for treatment not performed. Some patients have even assumed the identities of other people to get benefits for which they were not entitled.
The second kind of fraud is perpetuated by a doctor or doctor’s staff member. In this case, a claim is generated for treatment not performed. This can be as simple as changing the date on a claim form, claiming a three surface restoration was done when in reality a two surface was done, or routinely forgiving co-payment to diminish or eliminate the patient’s liability. The more egregious examples can include submitting claims for patients of record who did not have recent treatment, or “padding” the claim by adding additional work (i.e. one crown done, submit for two). The fraud “blanket” also includes submitting claims for prosthetic dentistry before the case is inserted and mistakenly writing the wrong tooth number on a claim form. There seems to be a presumption of guilt here and the doctor has to prove his innocence! (Bizarre, isn’t it?)
The third kind of fraud is performed by insurance companies routinely. In these instances a claim is mysteriously “lost”, or benefits less than proper are paid, or more than a reasonable time is taken to pay the claim. Some other examples of insurance company fraud include changing the code of a procedure to one not performed only to pay a lesser amount, requesting irrelevant information from the doctor or patient, having a non- dentist, or dentist not licensed in New Jersey make treatment decisions, inappropriate coordination of benefits, inappropriate consultant review, lost or misplaced radiographs, incorrect assignment of benefits, and complete lack of response.
Surprisingly, or not surprisingly, the mandate of the State Fraud agency is to investigate only those instances of fraud promulgated by a patient or doctor, and not by the insurance industry (because we all know how honest they are!).
In over twenty years of practice, submitting insurance claims for patients and having benefits assigned to me, I have received many claims with errors. The insurance companies claim these errors are the result of “clerical errors”. Having had some very elementary statistics in college, I know that random events must fall into a bell-shaped distribution curve, where there are as many overage, as underage events and the vast majority are correct and right in the middle. I have received thousands of under payments. The amount of overpayments can be counted on one hand. Where is the bell-shaped curve, or is there some diabolical direction here? Does the insurance industry have an organized policy to underpay? Even though I have had several patients who were claims examiners and they stated that there is an organized underpayment policy, I really don’t know.
Organized dentistry is not asking for much. We just want a level playing field. Sure, dentist and patients should be punished for stealing thousands of dollars by fraud. But shouldn’t the insurance industry be similarly punished for stealing millions?
All of the opinions expressed are my own; however I try to base them on current facts and information. My primary source of information is CDT-3/2000, American Dental Association, 1999.
Daniel B. Krantz, DDS
Middlesex Representative to
Council on Dental Benefits