The government is to act against cowboy dentists, following The Observer 's revelations that £200 million worth of unnecessary work is carried out each year and 90 per cent of all dentistry is substandard. Meanwhile, whistle-blowing dentists continue to reveal details of the profession's systematic defrauding of the National Health Service. Lord Hunt, the Minister responsible for dentists, has promised to introduce a system whereby dentists would audit each other's work and to bring the profession under closer scrutiny. He said: 'I am concerned about the variations in the quality of work.' Poor performers would have to be retrained, he said, and regional health authorities, which currently largely ignore dentists, would be responsible for monitoring them closely. The full reforms will be announced in July.
In a passionate plea to clean up the profession, one dentist wrote to The Observer, claiming that most of his colleagues were boosting their earnings by making false claims for NHS payments: 'I estimate that 10 per cent of the profession are blatantly fraudulent, with another 15 per cent working in the "grey areas". Add to that a further 30 per cent who are chancing it occasionally, and you have a majority of the profession who are committing some degree of fraud.'
Frauds include overcharging patients, claiming fees for work that wasn't done, and doing cheap treatments but claiming fees for expensive ones. The dentist concluded: 'Sadly, dentistry is a very dirty/shady profession, in dire need of exposure. There are many deeply caring and hard-working dentists out there who are being let down by the cowboys ... it is a profession that is slowly sliding into the mire.'
Another dentist, from the north of England, admitted: 'NHS dentists virtually can't work without fraud. People are forced into fraud because the fees are so low. It is very widespread. For the older ones, it is just how they work the system.'
The dentists detailed dozens of scams that are widespread in the profession, of which the most straightforward include:
* Charging full private fees for work, and then also claiming payment on the NHS.
* Charging the patient the NHS fee, but then claiming the patient is on benefits and entitled to free treatment, and recouping the full amount from the Government.
* Fitting a non-precious alloy crown, but claiming fees for an expensive precious metal one. 'It's a very safe form of fraudulent claim because you can only prove it by removing the work from the patient and analysing it,' said one dentist.
* Claiming fees for repairing braces, work which it is impossible to prove whether or not it has been done. 'Most practitioners will claim these fees on a regular basis to boost fee income, because they are never checked.'
* Dentists - who are entitled to claim a one-off £50 fee for opening over the weekend - line up many patients back to back on Saturday and claim the fee for each one. 'So many dentists totally abuse this,' said one dentist.
* A less common scam includes inventing patients and claiming fees for work that is not done. A reputable dentist said: 'I know this works, because I have done it to test out the system. I have been paid for non-existent treatment on non-existent patients. However I have refunded it.'
Another said he was shocked when he first started work after training: 'I was in a situation when it was almost forced on me. It is part of the philosophy of the practice. It's the way things are done and you just fall in with it.'
One dentist said: 'If you are clever about it, you do things that people can't check. The chances of getting caught are virtually nil.' Another dentist added: 'It's an absolute scandal that this is allowed to go on. There is no other form of business where monitoring of payments is so slack, and where the consumer doesn't know or understand what they are paying for. NHS dentistry is nothing more than a scam for the cowboys/girls, and it could be tightened up tomorrow if anyone had the courage to do it.'
Anthony Kravitz, chairman of the general dental services committee of the British Dental Association - the trade union for dentists - said he had no idea how much fraud there was, but insisted 'fraud of any kind cannot be tolerated and any dentist involved in fraudulent claims must be dealt with. Defrauding the NHS whether you are a patient or a dentist is totally unacceptable. We want to see fraud in dentistry eradicated because it diverts funding away from patient care. The systems for detecting fraud in dentistry are already in place and are far more developed in dentistry than in other areas of medicine.'
anthony.browne@observer.co.uk
