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Out of Prison, Dr. Roy Shelburne Has a Message

May 24, 2010

Document, document, document!

by Penny E. Anderson
Senior Editor
Dental Economics

Dr. Roy Shelburne is on a mission. After serving 19 months of a 24-month sentence in a Kentucky prison camp following his conviction on felony charges, racketeering, health care fraud, and structuring a financial transaction, the Virginia dentist has an important message for his colleagues. That message is “document, document, document!”

Dr. Shelburne was released from a halfway house on May 14. Seventy-two hours later, he attended a meeting of the Speaking Consultant Network in Anahein, Calif., hosted by Linda Miles. While at the meeting, he sat down with DE Managing Editor Kevin Henry for a video interview about the past 19 months and his plans for the future.

“I spent a lot of time writing while in prison,” Dr. Shelburne told Henry. “I heard from a lot of people in the dental community ... dentists from all over the United States. The outpouring was amazing, and I appreciate everything the dental community has done to support me and to try and help me and my family.”

He went on to tell Henry that in many ways, the aftermath of his conviction was a lot harder on his family than on him. “They were still in the real world and they didn’t have a husband and father to lean on. They had to deal with a lot of situations that I didn’t have to deal with because I was away in prison. It was an experience I wouldn’t wish on anyone.”

Shelburne said going through this ordeal helped him focus on what’s really important and why it’s important. “It clears out a lot of the junk in your life that’s not important,” he explained.

“My greatest goal in life now is to tell other dentists about what I’ve learned from this experience and my shortcomings as it relates to recordkeeping and how I practiced dentistry. There is a way to practice dentistry that is proper, but it is also defensive and necessary. Recordkeeping is paramount!”

When I first hear about Dr. Shelburne case almost two years ago, I visited with two expert witnesses who testified on his behalf. One, Dr. Susan Phillips, is an insurance consultant with a claims review organization. Dr. Phillips has been a consultant on claims reviews for over 20 years. She told me that after reviewing all of the documentation about the dentistry performed in this case, she felt the charges did not have merit. “I saw no pattern or scheme to defraud, and I’m very familiar with what to look for because reviewing claims and records for fraudulent or suspicious submissions is a routine part of my job.”

What Dr. Phillips did see was a doctor who had delegated more duties to his staff, as many doctors do, but who didn’t provide adequate oversight of what his staff was doing and how they were carrying out their responsibilities.”

Clearly, Dr. Shelburne has come to that realization in the time he has had to review his actions. He now says, “When you are called on to give an account of what you did and why you did it, it’s not good enough that you relay that after the fact. It has to be a part of that permanent record.

“One of the most difficult times for me during the trial was sitting on the witness stand and being cross-examined by the prosecution. He asked why I provided a particular service. I outlined why I did it, and the prosecutor went back to my patient record and said, “Well, that’s not explained completely in this record. So, how do you now justify what you did then when you did not fully record it? This seems like you are saying this to protect yourself after the fact.”

Dr. Shelburne said he told the prosecutor if he performed a restoration, there was an obvious reason for it. The prosecutor then turned around to the jury box and said, “It’s not in the record, though, is it?” And I had to say, “No sir, it’s not.” The prosecutor’s response was, “I guess we just have to take your word for it.”

“Mistakes happen in all dental offices,” Dr. Phillips, the claims review consultant, told us, “but the dentist has final responsibility for everything that happens in the office. It’s hard to oversee every little thing when you are the major income-producer for the office and working at the chair all day. But it must be done!

“You may say that’s my front desk manager’s or my financial coordinator’s job to make sure procedures are coded correctly or claim forms properly filled out, but ultimately, it’s the dentist’s responsibility,” she emphasized.

I conducted an interview with Dr. Shelburne shortly before he went to prison. He answered every question I put to him about the trial itself and his take on the reasons behind his conviction. He remarked then that hindsight is 20/20, and if he could do it all over again, he would take a much more active role in the every day business operation of his practice. That would include, he said, more in-depth charting and recordkeeping and implementing a system of checks and balances.

“My message to the dental community is if it’s not in the dental record, it doesn’t exist,” Dr. Shelburne told Henry in the video interview. “If you perform a procedure and you don’t record it or don’t record what you did completely, there’s no evidence that you performed that service,” he emphasized.

“Be careful not only with how you record your services,” he continued, “but how you bill for them. For the most part, we have very dedicated and competent employees who are submitting these claims. However, that claim is a legal and binding document — the information contained in that claim can be binding in terms of how reviewers view the truthfulness and completeness of that billing.

“Bill what you did, exactly what you did, and when you did it. Make sure it’s done in a timely and accurate manner, and do your due diligence. Go back, review, make sure that everything you did is on that claim and coded correctly.

“I urge all dentists to make sure they know what goes on in their practices in terms of billing because a mistake is not necessarily a mistake in the eyes of the law. Ignorance is no excuse! We are responsible as practitioners and owners of our businesses for whatever goes out of our offices.

“Be very careful. Be diligent and be precise, because you may be called on one day to justify the services you have provided. You should be comfortable saying this is exactly what I did, and this is what I need to be paid for that service.”