Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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707 Dental Compliance Specialists with Duane Tinker : Dentistry Uncensored with Howard Farran

707 Dental Compliance Specialists with Duane Tinker : Dentistry Uncensored with Howard Farran

5/12/2017 11:37:40 AM   |   Comments: 0   |   Views: 392

707 Dental Compliance Specialists with Duane Tinker : Dentistry Uncensored with Howard Farran

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707 Dental Compliance Specialists with Duane Tinker : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #707 - Duane Tinker

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AUDIO - DUwHF #707 - Duane Tinker

Duane Tinker is a former law enforcement officer/investigator for the Texas Dental Board. He investigated dentists for issues ranging from patient complaints to insurance/Medicaid fraud, drug diversion and even infection control problems. It is his experience that most dentists and their staff strive to do what is right when they know what ‘right’ is. He quickly recognized a huge gap between what dentists know versus what dentists should know. He decided to become an ally for the dental community. Present day, Tink is the President & CEO of Dental Compliance Specialists. His company provides audit, inspection and training services to help make dental offices safer for dentists, patients and staff. When he’s not busy working with dentists and their staff you will likely find him Scuba diving in Belize. 

Howard Farran: It's just a huge honor today to be sitting in my home podcast interviewing Duane Tinker. Thank you so much for coming over today. 

Duane Tinker: Thanks for having me. 

Howard Farran: This is gonna be so interesting. Duane Tinker is a former law enforcement officer, that's how I met him. He was arresting all four of my sons at the same time. He was an investigator for the Texas Dental Board. He investigated dentists for issues ranging from patient complaints to insurance/medicaid fraud, drug diversion, and even infection control problems. It is his experience that most dentists and their staff strive to do what is right when they know what right is. He quickly recognized a huge gap between what dentists know versus what dentists should know. He decided to become an ally for the dental community, present day Tink is the president and CEO of Dental Compliance Specialists. His company provides audit, inspection and training services to help dental offices safer for dentists, patients and staff. When he's not busy working with dentists and their staff, you will likely find him scuba diving in Belize. It is my distinct privilege to introduce Duane Tinker, aka the Tooth Cop.  

Thank you so much for coming over. By the way, Ryan you missed the seminar I did in Belize, it was Michael Melkers had a seminar out there and I took Zack and Greg. I loved it because the boys ... You know, when you live in the desert, you can whine in the summers that it's so hot but what people don't realize, the desert basically doesn't have any insects. My God Zack and me and Greg, we were pouring DDT all over us. We looked like we had chicken pox. We ended up staying in the house most time because if you went and enjoyed the ocean, you were just eaten alive. How do you avoid all the insects in Belize? 

Duane Tinker: I scuba dive. I spend most of my time under water.  

Howard Farran: Stay under water. 

Duane Tinker: Under water, eat, sleep or dive. That's all I do. We do live aboard trips out there.  

Howard Farran: Liver board? 

Duane Tinker: Live aboard. Yeah, you get on a boat, you go out for seven days and you either eat, sleep or dive. So, whatever you did last is last in the rotation.  

Howard Farran: Wow. 

Duane Tinker: So, it's pretty awesome. 

Howard Farran: Now you live in Dallas. 

Duane Tinker: Yes sir. 

Howard Farran: Dallas, is that where you were born and raised? 

Duane Tinker: No, born and raised in Minnesota actually. I got to Texas as quick as I could. 

Howard Farran: Where at in Minnesota? 

Duane Tinker: St. Paul. 

Howard Farran: St. Paul, Minnesota? 

Duane Tinker: Yeah. 

Howard Farran: Yeah, my sister's Cloistered Carmelite Catholic Monasteries in Lake Elmo.  

Duane Tinker: Okay. I know where that is. 

Howard Farran: You know where that is? Suburb. To go visit her I have to do business for four hours and one minute. So, I either abuse Patterson or 3M. I would go sit with a founder of the guy [inaudible 00:02:36] and I'd sit in his office and bother him for four hours and one minute or I'd go to 3M and talk to their organic chemist. What are you doing? I'm on your website right now, and if homies went to, what do they find? What are you doing? 

Duane Tinker: Well, we're working with dental offices trying to be proactive and preventing problems with government agencies. Having been a government agent, I know what's that's like to walk into an office to look at one issue and find 10 other issues and forget why I was there in the first place. If I could bring that to a dental office and help them to prevent the kind of problems that I used to investigate and make the office safer for the dentist, the patients and the staff. 

Howard Farran: My 30 year anniversary from dental school graduation is tomorrow, May 11th, and when I got out of school, the new big government agency that scared everybody was OSHA. 

Duane Tinker: OSHA, right. 

Howard Farran: Then it seemed like it was about 10-15 years later it was HIPAA. What are the government agencies that these dentists should be more prepared for and compliant with? 

Duane Tinker: I tell you what, I work with a lot of different government agencies and there's a lot of rules and regulations that affect a dental office. You've got OSHA, OCR, your state dental board- 

Howard Farran: OCR? 

Duane Tinker: Yep, Office for Civil Rights. DEA, your state dental board. I tell you what, we work with a lot of clients. Most of what we do is preventative but there's two agencies that cause me to lose sleep, one especially lately. That is Medicaid and OCR, regarding HIPAA issues.  

Howard Farran: Oh, OCR, Office for Civil Rights is HIPAA? 

Duane Tinker: That's the HIPAA police, yep. 

Howard Farran: I've never even heard of OCR. I must not be OCD enough, if I never heard. So HIPAA, H-I-P-P-A? 

Duane Tinker: P-A-A. 

Howard Farran: H-I-P-A-A? And what does that stand for, for my international ears? 

Duane Tinker: Health Information Portability and Accountability Act.  

Howard Farran: Okay, so Medicaid is ... I guess the bottom line is when you're dealing with the feds, if they find something wrong they can really change your life. They can throw you in jail. 

Duane Tinker: Yeah and that's true. We think about things like Medicaid fraud and whatever, people develop this image in their mind of a villain as a person, someone who's a crook, somebody who's trying to cheat the system. Dentistry's a small community and people know, there's people out there that are doing that but people that can face consequences are not those people but people that make innocent mistakes for not following certain rules and certain requirements, [inaudible 00:05:19] of requirements. Maybe not even making those mistakes on purpose. When you're dealing with the kings purse, the kings coin, you've got to subscribe to the kings rules and sometimes it's hard to keep up with what those rules and regulations are.  

Howard Farran: When we were in dental school, we could go out to Leavenworth prison and we loved it because in dental school it literally would take you all day to get a filling done. The bureaucracy, the waiting for a check but you could go out to the prison and do 10 fillings in one day, so it was awesome. But I remember, the number one thing that I remember from Leavenworth prison is that everyone in that place is innocent. There's not a guilty person in prison and sometimes these dentists get busted for Medicaid fraud and they say, "Well, my receptionist was billing it wrong." So they're always innocent but I always wonder, I haven't met too many humans that say, "Yep. I messed up. I'm guilty." Seems like most people just say, "I'm not guilty. [inaudible 00:06:22]." Do you think these cases that you've seen posted on Facebook for the last five years of them going in there in some dentist was billing something wrong, whatever and they crack down on them really hard and put them in jail. What percent of that do you think is ignorance versus he knew exactly what he was doing? 

Duane Tinker: Probably a lot part of that is he knew exactly what he was doing but ignorance is certainly a considerable factor. The unfortunate reality is the feds, they don't care.  

Howard Farran: They don't care if you were intentionally doing it. [crosstalk 00:06:54] 

Duane Tinker: They don't care what your intent is. You're right. 

Howard Farran: I notice it's different with the DEA, it seems like in the 30 years, everybody on DentalTown who the DEA showed up and they were diverting writing to whatever, if you just raised your hand and said, "I'm sorry. I know. You got me. I can't stop," they're all nice and compassionate.  

Duane Tinker: Surrender. 

Howard Farran: They take them to the board and they put them the Betty Ford Center but if you deny it and then they prove that you're diverting, oh my God- 

Duane Tinker: The gloves are off. You're screwed. 

Howard Farran: So the DEA seems to care if you're sorry versus lying but what about Medicaid? 

Duane Tinker: To some degree. What they're looking for is ... attitude is everything. When you're dealing with a government agency, that is not the time to display your ego.  

Howard Farran: Yeah. 

Duane Tinker: Really. I think a lot of the larger settlements, a lot of the reasons why we see dentists get hammered is because they're playing their ego. 

Howard Farran: Oh, yeah. I tell every dentist, "My God. If you're addicted to opioids, you better get help cause if you go in there and say, I need help, they're loving but if they find you and your ego shows up and you think you're smarter than that and you lie. Oh my God, it's real-" 

Duane Tinker: Think about the empire that you've got. Whether you've got one practice or fifty. There's a guy in Dallas, just lost his dental license. Built a successful organization there, lost his license, it's not suspended, gone because he refused to deal with his drug problem. He was forced to sell his practices and get out. 

Howard Farran: Speaking of Belize. I've lectured in 50 countries, whenever I'm in one of those countries and I meet an American dentist, nine out of ten it's cause they had their license taken away for prescriptions and they just sit there and said, "You know what? I'm not gonna stop doing Vicodin, I'm just gonna move to Mexico, Belize." You go to ... I can't tell you how many countries I've met American dentists and ... Is that what that guy in Dallas is gonna do? You think he's gonna go down to Mexico? 

Duane Tinker: I don't know.  

Howard Farran: Right now, if my homies go to ... When I go to work, I'm mostly doing fillings, crowns, root canals. What is your filling and crown and root canal? Who is calling you and what is your top three menu items that you sell at McDonald's? What's your Big Mac, fry and a coke? 

Duane Tinker: It's gonna be chart auditing, help with HIPAA, help with OSHA or infection control, by far. We're one of the few companies in the U.S. that I'm aware of that does billing and record audits. We're looking at it from a critical perspective but we're not looking to recoup money. This is a safe place where dentists can go and have their records audited and get objective feedback where it's not gonna affect their pocketbook except for whatever it's gonna cost us to audit their records.  

Howard Farran: Do you fly to the dentist location? 

Duane Tinker: We do everything remotely. 

Howard Farran: You do everything remotely. 

Duane Tinker: Yep. Everybody's got one of these in their pocket, a smartphone, why not utilize the technology that everybody has. We do office inspections, training, everything by video using your smartphone. 

Howard Farran: Nice. 

Duane Tinker: And that works. 

Howard Farran: How much does something like that cost?  

Duane Tinker: We have a couple different programs. We have what we call our compliance advantage program. 

Howard Farran: Compliance advantage program. 

Duane Tinker: Yes sir. We've got the silver program, which is ... We have two programs the silver is for not Medicaid folks and it's dealing with just OSHA, infection control, radiology- 

Howard Farran: SSR. So compliance, the first one was compliance advantage program and that's- 

Duane Tinker: Silver. 

Howard Farran: That's sliver. That's for non Medicaid. 

Duane Tinker: For non Medicaid, correct. 

Howard Farran: Non Medicaid and then you do? 

Duane Tinker: OSHA, HIPAA, infection control. 

Howard Farran: OSHA, HIPAA, infection control. 

Duane Tinker: Radiology compliance and if they have controlled substances in practice we also have a DEA module.  

Howard Farran: Yeah. That's really a bad ... I notice a scene change in that. When I got out of school in 1987, do you realize that back then, every single month, pharmaceutical sales reps would come off and drop samples of all kinds of narcotics. They were trying to get you to prescribe the brand name instead of substitution for permitted. Oh my God, that caused so many problems for so many dentists from assistants stealing them, so you never ... I don't think I've seen that ever in the last 15 years. That was something that was going on from about '87- 

Duane Tinker: Yeah, I don't see the drug reps dealing with dental offices very often.  

Howard Farran: Yeah. 

Duane Tinker: Now offices with drug problems, I see that a lot. 

Howard Farran: Do you see that a lot? 

Duane Tinker: Yeah. Diversion issues, not necessarily with the dentist but often times with the staff. They have easy access to prescription drugs, their doctors prescription pad, you'd be able to call in their prescriptions. I've seen staff members that make up fictitious patients and have one of their family go pick it up. 

Howard Farran: What percent of the time the DEA shows up is it staff versus dentist? 

Duane Tinker: I would say almost 50/50.  

Howard Farran: Access is a huge ... When I was young and dumb, I was a libertarian thought there basically shouldn't be a federal government but then when you start looking at the data, about 14% of dentists, they say, fall into substance abuse. Most of it alcohol, but prescriptions but they say the highest is the anesthesiologists because they're carrying it around and they say for them it's 40%.  

Duane Tinker: I've seen that too, I believe that's probably correct.  

Howard Farran: They say their one hit addiction they try it one time, they're done is Fentanyl. Ryan, can I tell you my Fentanyl story? 

Ryan: What? 

Howard Farran: Can I tell you my Fentanyl story? 

Duane Tinker: Please. 

Howard Farran: So, had Eric, the ex has it all natural. The second one, all natural. Third one, all natural. Fourth one, tired, exhausted, she couldn't do it. I talked her into getting an epidural because I hate this having a baby natural by Dr. Lamaze. Only a man could convince her to have a baby natural. I swear to God, I wanted to get Dr. Lamaze in my office and pull all four of his teeth naturally, while he was holding his wife's hand breathing and saying, "It's just pressure, it's just pressure." If Dr. Lamaze was having a nine pound baby, he'd have an IV. So I went to the anesthesiologist and I said, "Can I watch the epidural?" And he said, "Yeah." I said, "I'm a dentist. So what do you do?" He goes, "Well, I'm using the same thing you do, use lidocaine but no epi," and that's for the short acting fibers. He said, "But then we want a narcotic for the long acting and for that I use Fentanyl." And he shot it in there and the instant Ryan, he shoved that in there, your mom was like, "Holy moly. What is that?" And the guy goes, "That's Fentanyl." She goes, "Man, that is good stuff." I though, wow. That's the one hit deal, where if they try that personally, I guess the average person can never stop until they crash and go to rehab.  

Duane Tinker: Maybe. I mean, it's a huge problem in our country right now. I've seen a lot of people in upper class areas that are resorting to heroin because it's easier to get in some cases.  

Howard Farran: We had the Arizona Dental Association executor [inaudible 00:14:48] and he said that, he's been here 10 years and then he was in New Jersey for 10 years. He said for most dentists it started off innocent with prescriptions for back pain or something like that and then it led to, couldn't stop. So, yeah, it's a huge problem. That's another scene change I've seen. When I got out of school 30 years ago, the media was always, the dentist was essentially the bad guy. Grandma was dying of cancer, she's in pain, you won't give her anything, you think she's gonna be a drug addict. So we were the bad guy and I remember a lot of the older guys, it was really hard for them to start writing for a narcotic but we were so much under the press of look, you just did a root canal, you pulled her wisdom teeth, give her some medication.  

So the doctors started writing the prescription and now the pendulum has swung all the way to the other side. Now you've got 47,000 Americans died last year from an opiod overdose. Now, again, we're the bad guy again. It really needs to start swinging back. There's a lot of dentists I know in DentalTown that just said, they won't do it because when you're talking about compliance with DEA issue narcotics, you really open yourself up to getting broken into, stealing, theft, it's just so many problems you eliminate if you just don't have anything in your office.  

Duane Tinker: There's liability issues both ways. If dentists are doing in office sedation they would rather write the prescription for their pain medicine for their sedatives, have the patient go and pick it up and bring it into the office and take into office, to avoid having to deal with the record issues. Dentists in Dallas fears go to that very thing. The patient was on the way to the appointment and struck and killed a pedestrian. It hit the paper that the patient was on the way to the dental office for a procedure and had taken a sedative. Whether he did or didn't, I don't know where that situation panned out in court. Even if it didn't happen, that's the way it hit the paper and Howard, as you know, public perception, what's portrayed in the media, what people perceive, that's the only thing they remember. That's the only thing that matters sometimes. PR issue for the dentist, considerable. 

Howard Farran: Perception is reality. I'll never forget, there was center, I think it was Gary Hard out in Colorado ad he was moving up the ladder, I think he was gonna be a presidential nomination, then there showed up a picture of a married man on the back of a yacht. The yacht was named monkey business and she was sitting on his lap. 

Duane Tinker: Done. 

Howard Farran: Done. Every person who saw that picture said, "Oh my God. He's cheating on his wife." He was dead in one second. No one ever knows. He was a politician so I know he was doing it but yeah, perception is reality. Let's go from ... So, Texas is, I mean come on, Texas is one of the most redneck, Republican, conservative states in the Union, one last question on DEA. If a dentist is addiction to opiates in Texas, are they compassionate, the board if you go in there and tell your dental society or the DEA you have a problem or are they still- 

Duane Tinker: I wouldn't go to the board but they can go to a professional recovery network, part of their licensing fee is actually funds this group of social workers from PRN and they're attached to the board of pharmacy they can go and get help anonymously. Not have it reported, not have to deal with the state board but if you get caught, it's a different animal. 

Howard Farran: Wow, now what is this? 

Duane Tinker: It's called the Professional Recovery Network and I'm certain that most states have a similar- 

Howard Farran: Ryan can you see if you can find Professional Recovery Network? Ryan, that might be a hell of a resource because- 

Duane Tinker: You want a cool interview, I can hook you up with somebody from PRN. 

Howard Farran: Yeah! And I'd like an article on it. I always taught my editorial team, we should be covering this every two or three years because there are ... I know a dentist in Arkansas who's sister I went to dental school with and graduated with, and he runs an alcohol rehab, only for dentists. He always has 20-30 dentists in there year round, for decades. I told my staff, we need to do that more often than not. Also, Kevin was talking yesterday that during the financial crisis of 2009, drove a lot of people to drink during the job. 

Duane Tinker: Drinking but also, I'm seeing, I wouldn't say an increase but I seem to hear of a number of stories about dentists abusing nitrous. Usually when they get busted, they're getting turned in by their staff.  

Howard Farran: I got to tell you some nitrous stories. Again, I'm a grandpa but I've got a five year old granddaughter and a one year old grandson, when I got out of school, the old units, you could still go to 100%. At least every year in the newspapers, the staff would come to work in the morning and dog had died after work the night before and he's sitting there on 100% nitrogen. Then there was a big push to make it so it could not go to 100%. I think they cap ... I think mines cap at 70%. They used to be a lot of carnage. I'd say in my first 10 years on DentalTown, probably 10 dentists were discovered by their staff in the morning on nitrous. 

Duane Tinker: Here it is 2017, I still see some of those older nitrous units in dental offices.  

Howard Farran: Really? 

Duane Tinker: Yep. 

Howard Farran: If someones commuting to work right now, eating two Vicodin and a diet coke, what is the .... the website ix The Professional Recovery Network is a nationally recognized pure assistance program dedicated to helping healthcare professionals and are a safe healthy recover. Our program is started by 1,000 healthcare professionals. Says it was established by Texas Pharmacy Association. So is it just a state deal for Texas or is it cover the United States? 

Duane Tinker: It is. No, it's just a Texas thing but like I said, I believe that every state has a version of this.  

Howard Farran: And you can hook me up with someone from there? 

Duane Tinker: Yeah, I absolutely can.  

Howard Farran: I would love that because it's gone from being a moral issue, like it was 30 years ago, you were a sinner, you were bad and you needed spanked to now a lot of people see it as a disease. That you were born with addictive genes, you have a more addictive personality. Do you think it's more moral or disease? 

Duane Tinker: I would say it's more of a disease really. 

Howard Farran: Yeah. 

Duane Tinker: There's some people that are just more prone to addiction than others. 

Howard Farran: Yeah, the biggest study I've ever wished somebody could do and I always have pediatric dentists say, I've noticed my whole life. When you're in college, some girls don't want to have more than two beers because they'll tell you, they just don't want to lose control. Then there's the other girls slamming a shot of fireball and a chaser and she just wants to lose control. I notice in PETO, for 30 years I've done pulpotomys and crowns on kids, when I put that nitrous on them, it seems like about half the kids don't like it. Some are scared like, just take it off like, "Uh, what the hell's that?" Then it seems like, Ryan, about a third of the kids, they're four years old and they'll say, "What is this? I like this." 

It's like someone needs to do a longitudinal study to see if that's the kid in rehab at 21 versus the other one that just never wants to lose control. I think it's a bigger issue with girls, seems like the majority of girls don't want to lose control whereas almost every man just was born to lose control. They're just not afraid losing control. It's probably safer for a man to lose control than a woman to lose control. I always wanted to do a longitudinal study, this kid was obviously born different and loved the nitrous at four when he doesn't know what it is versus someone who rips it off because they didn't like that feeling. 

Duane Tinker: I'm most curious, if someone does a study like that, look at their history of childhood trauma and see if there's any association there. Bet you'd find a strong corelation. 

Howard Farran: Yeah. That's what all four of my boys say. That's what they go do every night. We crushed DEA and the Professional Recovery Network, if anything guys, if you went to TXPRN, they have a helpline number 1-800-722-5152, 1-800-722-5152. I'm sure, at least, if there was another one in your state, I'm sure they could direct you somewhere.  

Duane Tinker: I just want to point out, before we move on here Howard, they deal with substance abuse but also mental health issues. When I was with the dental board, I had two dentists that committed suicide. Both of those cases were standards of care investigations that, in my experience, I didn't see but maybe a disciplinary action. I definitely did not see the dentist facing losing their license. Dentistry draws a certain personality trait- 

Howard Farran: But when they were under investigation, they killed themselves? 

Duane Tinker: Yeah, they were worried that they were gonna lose their license Howard. They were terrified that everything that they worked for was gonna disappear. I find that most dentists are like perfectionists. They have that internal motivation, that internal need for perfectionism and they have somebody call that out and to realize that you could lose everything, even if that's not the reality, but that's the perception that you have. To see that manifest by way of suicide, get help, you need it. 

Howard Farran: Yeah and that's the problem because of the damn deans. The deans of the dental school want all the 4.0's. The 4.0's lived in a library, they're not well rounded, they're perfectionists, they're crazy, they're ... If any amazing well rounded person in college who made A's, B's, C's, did volunteer work, in a frat, went back on weekends and helped his grandma, any form of being a well rounded person you would never be a physician, a dentist, or a lawyer in America. The natural selection ... And the dean's, it's even worse with these U.S. news and world report rankings, they want the best of the best so they can rank number one. 

It's kinda like the priesthood. My two older sisters are Catholic nuns and when you say, "I can only accept you if you're a man and never get married, never have sex and never have a family," you don't get the average guy. That comes from Rome. We've seen church scandals and all these people complain about the church and I say, "Well, why don't you run your dental office where every one of your employees has to be a male virgin that doesn't get married or have children." The priests didn't have to do that the first 1,000 years of the Catholic church and they need to reverse that. I look at all the Lutheran ministers in my office, which by the way, Howard is there's three of them, their first name is Don. So they're all Lutheran ministers and three out of four have the first name Don, they just seem so much more well rounded and normal because they can hire someone who wants to have a family.  

If the deans would back off this insane requirements and who cares if you get an A in physics and chemistry and biology, you're never gonna use any of that shit anyway. What's more important is that you can communicate with a patient, you have empathy for the patient. I'd rather pick a kid who was big in scouting and volunteering and spent a lot of time helping the elder in nursing homes than some guy that got an A+ in organic chemistry. It's not even matching the skill set. 

Duane Tinker: Soft skills are so important today.  

Howard Farran: If you don't have empathy and you don't have sympathy and you can't communicate, you're in the wrong profession because these patients pick it up in three seconds. 

Duane Tinker: They demand it today. 

Howard Farran: In 1950, whatever the doctor said, everybody respected authority and said, "Okay, do it." Now, I talk to my patients here, pediatricians, and one out of four women say, "You're not giving my kids vaccines." So they have to spend a lot of time and a lot of ... you have to think long term care, she's not ready now but if I keep talking to her and talking to her, maybe when the kid's one or two or three. Some of them, they're never gonna get. It's a whole different ball game. 

Duane Tinker: It is. 

Howard Farran: You want to move on to ... What do you want to do next? OSHA or HIPAA. 

Duane Tinker: Let's talk about HIPAA cause that seems to be the big animal today. Certainly the one I want to talk about the most because it's the one I deal with the most from a problem standpoint.  

Howard Farran: Go back to the history of that. Some of these kids might have thought HIPAA was started by George Washington. When did HIPAA come about and why did that all come about.  

Duane Tinker: It really started to come about around '98 or so. Really hit the scene about 2003 for HIPAA privacy rule, 2005 for the security rule and things have evolved since then. 2009 we had the high tech act, which kinda give some additional requirements and added another set of responsibilities. 2013, the final omnibus rule, gave us some additional clarity on what OCR's expectation is for business associates and covered entities. Which covered entities, that's like healthcare providers. Dental offices, people that we do business with. In the recent four, five, six years more and more states are realizing that HIPAA doesn't go far enough in their requirements for dentists to protect patients information. A lot of states are adding more stringent requirements than the federal standard. This isn't being very well received. There's a lot of dentists out there that don't like government regulations and I get it. I don't do compliance because I like government regulations.  

Howard Farran: You say you do or don't. 

Duane Tinker: I don't. No, I'm a former government agent. You think, hey, you know. 

Howard Farran: So, how old were you when you moved from Minnesota to Texas? 

Duane Tinker: I was 22.  

Howard Farran: Yeah, so you've lived 20 years in Texas.  

Duane Tinker: Oh yeah.  

Howard Farran: Going around the world, many, many cultures want a partnership with the government. All of Scandinavia, Denmark, Sweden, Norway, Finland, so many countries, Australia, New Zealand, Canada, they're like a partnership with the government but it's very unique in America where it just seems like over 51% of American's don't want anything to do with the government. It's a cultural thing.  

Duane Tinker: That's how America was founded. 

Howard Farran: I mean, Ronald Regan won presidency because he said, "The government is the problem, they're not the solution." 

Duane Tinker: Right. 

Howard Farran: He campaigned on that that these guys aren't gonna fix any of your problems. These guys cause all your problems and that was the beginning of this serious dysfunctional rip between business and government. So if you're in America, you always approach the government, over half, but I think dentists are far more conservative than the American electric. In fact, the executive director of the Arizona Dental Association was saying yesterday, he goes, "Dentists are conservative. They're just massively conservative." So they don't like all this stuff, this HIPAA stuff. 

Duane Tinker: No, I agree. I understand. And to think I used to be part of the problem. I used to be that guy that'd walk in and say, "I am from the government, I'm here to help." When now I can look back and laugh at it, it wasn't a laughing matter when I was in the thick of things. Now I realize- 

Howard Farran: The only thing I ... the major beef I have with HIPAA is we have to do all this stuff to protect information while that patient posts every personal thing in their life on Facebook, including their cell phone number, their emails, their babies birthdate. It's like, again, that's that culture thing. She has no problem posting everything on Facebook but dealing with the government, I don't want to tell you my name.  

Duane Tinker: Yep, I get it. 

Howard Farran: Do you think HIPAA could be something that, I mean, Trump's counseling things right now. Do you think HIPAA's something that's not going away? 

Duane Tinker: I think [crosstalk 00:30:42]. Affordable Care Act, I'm sure that's probably just a matter of days until it's gone.  

Howard Farran: Seriously? 

Duane Tinker: Well- 

Howard Farran: Oh, the Affordable Care Act, Obamacare. 

Duane Tinker: A lot of the requirements that we see, a lot of the compliance requirements we see in Affordable Care Act, I'm pretty sure they're gonna transcend into whatever we had before. The government's gotten that certain level of power and strength, they're not gonna reduce that. They're still gonna have the same compliance requirements, they be labeled differently but they're still gonna expect people to do what they call the right thing.  

Howard Farran: So Socrates said that humans have two emotions, fear and greed. Let's start with the fear. If this guy's listening and says, "Screw HIPAA, I don't care." What's the worst case scenario for him? At home, "He's saying screw HIPAA, I'm no gonna comply." 

Duane Tinker: It doesn't matter who you are, what kind of background you have, they'll kick your ass and take your money. Can I say that? 

Howard Farran: This is dentistry uncensored, you can say anything. Name a story you've seen where ... 

Duane Tinker: It's always easier work the dental offices when they're not in trouble, working preventatively but people don't buy prevention, they buy pain killer. I feel like we've kind of become that company that people go to when they're in trouble. They got their butt in a crack. I got one with a dentist in Dallas, had a patient that filed a complaint on them. Patient posted a scathing review, dentist was pissed off and thought, "Hey, what the heck? That's not right." Typed in a big old detailed response about things that he definitely should not have. You would look at it and go, "That was probably dumb."  

Howard Farran: Maybe [inaudible 00:32:12] because he said the tooth number- [crosstalk 00:32:16] 

Duane Tinker: Tooth number, the amount that she owed, her unwillingness to cooperate, just totally detailed what happened with her and also the financial record and most people look at that and go, "Oh God, that was completely in appropriate." Patient saw that, filed a complaint and said, "What?" OCR got involved and immediately the dentist is in the defensive position. Whenever you're dealing with the government you're always in the defensive, which we know is a weaker position. Hires an attorney, which I would never ... Can I pause for a second here? I would never deal with the government without an attorney. A lot of these dentists think, "I'm a doctor. I can do this." Don't do it, you're crazy. 

Howard Farran: Dentists know everything. They hire ... They sign five year real estate contracts and don't have a lawyer. They sign up for PPO contracts and don't even read the contract because they know everything. You gotta be humble. You gotta be humble.

Duane Tinker: Yeah, that's foolish. Very much so. Attorney calls me up and says, "Look, I've got a guy that's in trouble. We need to get him up to speed. We need to get him up to speed with compliance. We need what you do. Establishing their policies and procedures and help hold their hand. Get them up to speed. While they're being investigated." Low and behold, the dentist gets another scathing review, posted another detailed response. You know who found it was OCR. The first time, shame on you. We are gonna do some corrective action here, do a little education, tell you don't do this but you did it again? You watch, we're gonna see a very large fine from the situation here. 

Howard Farran: What do you think it could be?

Duane Tinker: Oh, it's gonna be about a half million. 

Howard Farran: Yeah, all because of his ego. You know what? They say, I've podcasted SCO marketing people and they say that when a human goes to Yelp or whatever, and they see 50 five star reviews and no 4, 3, 2, 1, it's not even believable. 

Duane Tinker: Right.

Howard Farran: Because here's the thing about ... Okay, if I go to my Thanksgiving dinner family with the whole family, at least three of my uncles are nuts. They expect to see five people say, "You're the greatest thing since sliced bread," and one that says, "You suck." Dentists, they just gotta let it go.

Duane Tinker: Right. There's nothing wrong with posting a response saying, "Hey, I understand that you had an unfortunate experience here. We strive to put forth our very best and sometimes things don't work." 

Howard Farran: That's what they say, show empathy. "I am so sorry. I am so sorry things didn't work out. If there's anything I can ever do please let our office know." To show empathy to your crazy aunt. 

Duane Tinker: I had a dentist call me up one day about four or five years ago and he had a problem with a patient, didn't know how to respond to it. I said, "Well, doctor, did you call them and talk to the patient?" "Oh no, I can't do that. I'm the doctor." I said, "No, that's exactly why you need to." It was after hours, it was just he and I, there was nobody for him to delegate to. I said, "Why don't you pick up the phone and call her?" This patient was threatening to sue him and all that. He did and he smoothed it over. He was like, "Man, I can't believe that worked." That's all people want is to feel acknowledged by their doctor. Get off your high horse and make that call.

Howard Farran: I know and if someone in your office is in charge of the online marketing or social media or whatever, at the morning huddle, if someone at the morning huddle says, "We had an anonymomys complaint and this is what she said." And in one sentence, one of you says, "Oh my God. That was Maryanne." Then they run to the phone to go call her, "Maryanne, why didn't ..." and then usually she deletes it, comes back, it's all communication. 

Duane Tinker: Right.

Howard Farran: By being humble, with empathy and sympathy instead of being arrogant. Anytime I've ever been on an airplane and I just lean over to the person next to me and says, "Hey, if you had to describe a dentist in three words, what would it be?" It's never sweet, adorable, I love them, he's the best thing in the world. It's arrogant, talks down to me, it's like I'm a student in a class having a nun smack my hand. You walk by hygiene rooms, they're all scolding their patients, all day long. That's old school, that's not 2017.

Duane Tinker: Don't ever sit next to me on a plane. I'm just kidding.

Howard Farran: So, what do you actually ... They call you up. You said you have two programs, you have the compliance advantage program silver, these are for the non Medicaid. What's the other one?

Duane Tinker: The other one's gold. 

Howard Farran: So you have gold and silver.

Duane Tinker: Yep.

Howard Farran: What percent of the dentists, would you say in Texas, are Medicaid providers?

Duane Tinker: I can't tell you that percentage. It's a pretty large number.

Howard Farran: It is a large number? 

Duane Tinker: Yeah.

Howard Farran: Huh. It's funny how all the states can't figure out why they have low or medium or high percentage but it always comes back to reimbursement. If you pay the dentist 30% of their fee schedule and then you wonder why only 10% of the dentists participate. So, if they have a high utilization rate, hey have a higher fees schedule. So that's the gold plan. What does the gold plan cost? What does the silver plan cost?

Duane Tinker: The silver plan is $3,564 a year.

Howard Farran: $3,564 a year?

Duane Tinker: Yep. The gold plan is $4,764 a year.

Howard Farran: It's how much?

Duane Tinker: $4,764. A lot of people ...

Howard Farran: What is the deal with 64? 

Duane Tinker: What it is, it breaks down to a nice even monthly payment. It's $297 a month for silver or $397 a month for gold.

Howard Farran: $297 a month for silver and $397 a month ...

Duane Tinker: For gold, yeah.

Howard Farran: I'm just curious, why didn't you just go $300 a month and $400 a month?

Duane Tinker: I guess I could have.

Howard Farran: I know I repeat myself but you know why American's do that? They think that the reason things sell for $.99 is because psychologically it sounds less than a dollar. 

Duane Tinker: That's right.

Howard Farran: That is no science behind that. United States has more economists that have won the Nobel Prize in economics than any other country. Most of them are from the University of Chicago. There's no data to support that. What it is, is back before there were computers and you had a cash register and you needed some data points. One of the data points was I need to know how many transactions there were. So they would charge everything $.99 so you gave a dollar, they had to give a penny. So they'd start the day, they'd break open the roll or pennies, there's 50 pennies so now at the end of the day there's 20 pennies. So now I have one data point that there were 30 transactions. So, all the 99's was for internal control over peculation and auditing. They just wanted to measure transactions and it's folklore myth that the consumer responds differently to $.99 versus $1. 

For $297 a month, if they don't take Medicaid and for $397 a month if they do take Medicaid, what do you do for them?

Duane Tinker: About once every six to eight weeks we do an inspection of the office. We have dedicated appointment time with that practice.

Howard Farran: And that's through Facetime?

Duane Tinker: We use a different software but it works very much the same way.

Howard Farran: What do you use?

Duane Tinker: A product called Zoom.

Howard Farran: Zoom? Is that on their website or their smartphone?

Duane Tinker: Yeah. It's a secure communication link so we can do everything from video interface to I can share my screen, they can share their screen. We dedicate, do about an hour consult with them about every six to eight weeks. We're looking at one aspect of their practice each time. Rather than do a comprehensive audit or assessment of the practice and giving them a long detailed report, which is very daunting, very overwhelming. We feel like by breaking this up into smaller segments, we can look and take a little snapshot in one area, such as infection control. There's all kinds of infection control in dental offices and it's the little things. We slow down, we pause, we actually watch them process instruments, look at how their sterilization room is set up, watch how they disinfect their opeatories. Are they wearing PPE properly.

Howard Farran: PPE?

Duane Tinker: Yeah, personal protective equipment. Are they wearing their mask on their chin? Are they wearing clinical jackets when they should be, or not? It gives us a chance to kind of them that third party feedback. "Hey, heres the standard. Here's what you guys are doing. There's a little gap there. How do we ..." 

Howard Farran: That was one of the most disruptive things that the clinical jackets. The first couple of years I practiced before OSHA and then the HIV was coming out and the AIDS thing. I had to wear these clinical jackets. We're in Arizona, we're in the desert, it's 118 degrees outside. Every one of my staff always wears shorts and short sleeve shirts. Then OSHA made them wear long pants and did, oh my God. In fact, I had one hygienist said, "Howard, if you make me do that, I will quit." I was like. I didn't say anything but after a couple, two or three weeks, said "Come on. You gotta wear pants." It was just insane. Like someone could catch AIDS from something splashing on your leg. 

Duane Tinker: Yeah and I understand your point. The problem is if she does and she can point to the fact that you didn't enforce or make her wear them, guess who's eating that liability. 

Howard Farran: Yeah.

Duane Tinker: Is it worth it? Put the dang jacket on. It's not.

Howard Farran: I also think it's an ego thing when you go to 7-Eleven or Circle K and you'll see doc's in there wearing their scrubs. You can't wear your scrub there, to Circle K.

Duane Tinker: Certainly not if you're not wearing a clinical jacket over it and you've got other patients saliva all over you. That's gross but people don't think about it.

Howard Farran: They just want to ... I think they just go there and they want to rate another doctor. It's again, it's that ego thing. 

Duane Tinker: Right. 

Howard Farran: Are most of your clients in Texas or do you have clients in other states?

Duane Tinker: It's where we started Howard, but we've grown across state lines very quickly and word's gotten out about what we're doing. I think one of the reasons for our success is we really care about the people that we work with. I think that speaks volumes. 

Howard Farran: So, they should go do and what is the initial interview? Do they fill out a form? Do they call you? How does this process start usually? 

Duane Tinker: Well, there's a couple different ways we try to be accessible. We realize we're dealing with multiple generations of dentists, some are comfortable on the phone, some are comfortable ... We actually have people sign up without ever talking to us, right from our website using our chat function, which it's kinda cool when that happens. We have people call us and say, "Hey, I need some help. Help me out." It's a really easy process to get started, just call and say, "Hey, I'm in. What do we do?" We do this, most people put it on their credit card, we just hit their card every month and get to it. All we as for is a minimum 12 month commitment, after that it's month to month. I listened to your interview with the dental billing guy, and I love what you said in support of not having contracts. It's hard not to do that when we're doing compliance stuff, only because we start working the practice, get them into compliance and they sell the practice halfway through. 

Howard Farran: Okay, if you're driving down the road and your Twitter at Dental Compliance is @DDSCompliance and I just retweeted a tweet so you could find his contact by just going to Twitter and looking for the retweet. I just retweeted, MB2 finds commentary. Duane Tinker on YouTube. What is an MB2 find?

Duane Tinker: It is a dental group based out of Dallas that ended up having to settle with the government over some Medicaid issues.

Howard Farran: Oh so MB2 is Medicaid?

Duane Tinker: No, MB2 is a dental group. They're a DSO.

Howard Farran: Oh, okay. What was their story?

Duane Tinker: The long and the short of it is they, like a lot of organizations, when you represent a large footprint in Medicaid space, found themselves being audited and investigated and they found some issues regarding some of their marketing or advertising processes. Ultimately found some issues related to their billing to Medicaid. Basically said, "Hey, you're gonna enter into a settlement with us and we won't kick you out of the Medicaid program." That's what they did. They settled to pay back a pretty good sum of money and they're being monitored by third party and the government for five years.

Howard Farran: Do you usually do this? If one of my homies does this, is this something you can delegate? Is this something that the lead dental assistant should be your point of contact? Should it be the hygienist or does it nearly need to be the doctor?

Duane Tinker: No, I think this should be delegated. Like Ronald Regan says, "Trust but monitor." I always want a gateway to the dentist. We've had some staff members that have tried to cut us out. They're not showing up for the inspections, they're not following through on stuff. When we do the next inspection, we pause and say, "Hey, the things that we needed to fix from the last inspection, where are we at on that? Did you guys ... What did you do to correct those things?" Sometimes we catch people not doing things that they're supposed to or the staff members try and cut us out. I want to be able tot let the doctor know, "Hey, we had six no shows for your appointments and you need to know what's going on behind your back here." Whether it be embezzlement issues or staff members just trying to sneak by with things. We don't deal with embezzlement stuff but those are usually indicators that there may be a problem staff member. When somebody's trying to put distance and isolate the dentist from his staff and from their vendors. 

Howard Farran: So, what are you looking for on dental record auditing?

Duane Tinker: To make sure that your documentation supports what you're billing for and minimize your likely hood of having to pay recoupment due to insufficient documenting.

Howard Farran: I'm sure you know this but I'll just tell you. Every single dental malpractice attorney I've ever met or podcasted says that, when they get the charts and this whole thing is about a root canal he did on three and a crown, he gets to his chart and all it says is, "Root canal number 3." That was the whole notes. They say basically no one takes accurate notes.

Duane Tinker: I would agree, that's a pretty good assessment.

Howard Farran: If they get used malpractice it's a bad thing. In fact, here's another thing about their arrogance. Not only is it a bad thing but when they actually go to jail, it wasn't because of the initial root canal and a crown, it's cause they went in and altered the record and those lawyers said, those forensic people prove it every time.

Duane Tinker: Yep. 

Howard Farran: If it's on a computer they'll definitely prove it but even on paper. There's experts that can look at a note and says, "No, that was written at a later point than the first paragraph." 

Duane Tinker: Right. You know it's really-

Howard Farran: Do you agree with that or disagree?

Duane Tinker: No, I do agree with that. People try and sweep things under the reg and it just doesn't pan out. A lot of the things that dentists end up having to pay recoupment for are just innocent mistakes but you take it to a whole new level when you try and cover something up. 

Howard Farran: These dental records, is that ... What are they mostly doing wrong? What do you like to work on? 

Duane Tinker: More and more dental offices are using electronic records or some sort of EHR, Dentrix, Eagle Soft, whatever.

Howard Farran: Do you have any favorites on those?

Duane Tinker: Well, I'm kind of partial to both Eagle Soft and Dentrix just because you can populate whole templates into those notes very quickly and very easily. 

Howard Farran: What about Open Dental?

Duane Tinker: Same thing. 

Howard Farran: So you like Open Dental?

Duane Tinker: Yeah. 

Howard Farran: Do you hear that? A compliment for Dentrix and Eagle Soft on Dentistry Uncensored. Please tell your Patterson and Schein rep that Howard actually allowed a compliment for those two bastards on his show. I just will never forgive them that they won't hook it up to Quicken online. You have all your accounting here and all your dentistry here. Total schizophrenia. It would just solve so much, it would make life 25% easier if those guys would do that and they just don't care. But anyway, continue. So, when you audit, do you log into their Dentrix Soft and Eagle Soft?

Duane Tinker: Yeah, we do. We login and basically snap a screenshot so we don't have to spend hours and hours in their system. A lot of people don't have an extra computer laying around so we get in, we snap screenshots, we get out. Then we have the screenshots that we can audit from there. We're looking at their clinical notes, verifying that they have type and number of X-ray's that they billed for. We have the clinical notes, we have things of the medical history forms, concent forms, things like that. We're looking at comparing the billing ledger against their clinical notes and X-ray's and other supportive documents to day look, we're not dentists and we're not attorneys but as a [inaudible 00:49:14] person, does this make sense? Does the story make sense that how the patient presented that the dentist actually examined the patient, that the dentist actually did the treatment that they billed for. We talked just briefly about electronic software. They're great, I love that people can use templates but there are some inherent issues with them. They help to document a lot pertinent negatives.

Howard Farran: You know what I think the most important things in auditing, one of the most important things, you're talking about this one time event if you malpractice, get sued, or HIPAA compliant but as far as a daily thing, you can go into any dental office and at the end of the day audit the charts and find at least $200 sometimes $300 where, she took bitewings, didn't enter it, she took a PA, didn't enter it. Just the miss billing ... And here's the dental staff trying to squeeze in a patient, work through lunch, stay late, they're doing a good thing with their body but their brain it's like, my God, you worked through lunch for free because throughout the whole day between the hygienist and the doctor running two, three chairs you didn't even enter $300's worth. There are dental consultants who literally get recouped their entire cost just by getting them to go back and say, "Did everything done in the back get entered, so that front office can bill it out?"  Do you agree with that or disagree?

Duane Tinker: I absolutely do. Good gosh, that's where having audit processes can really pay off. Yeah. Do the math on that. You're missing $200, $300, $400 a day and you're probably missing more than that if you don't have some sort of process.

Howard Farran: It's people, processes, what's that guy in The Profit say? People-

Duane Tinker: Processes.

Howard Farran: People, Processes and what was the last P? People, processes-

Duane Tinker: Products, isn't it? No, it's not.

Howard Farran: Yeah, and product. I think that's it. That's just something that needs to be worked into the daily product. You're also available for study plans. We're huge in Texas. You do study programs?

Duane Tinker: I love doing study programs. It's a smaller, intimate setting. People feel more comfortable opening up and asking questions. What I do isn't rocket science but it's also something that people don't want to stand up and ask questions in front of large groups and out themselves.

Howard Farran: I love your name, The Tooth Cop. I'll tell you the biggest study club in dentistry is on the website and the app. Old guys like me go to conventions and brick deals but we started the online CE and we put up 350 courses and they're coming up on a million views. 

Duane Tinker: Wow.

Howard Farran: You should record a study club or do an online CE course on this DEA, HIPAA, infection control. You haven't talked about radiological complaints. Talk about that.

Duane Tinker: Some states have different ... Every state has X-ray requirements, some states like Missouri have none. Basically, get a registration and that's it. Then you've got Texas where they have state inspectors that go out to the office every four or eight years and do a physical assessment of your machines to verify that you paid your registration. They're on the far opposite end of that spectrum from Missouri. People are paying fines for things that shouldn't have happened, fault on the practice.

Howard Farran: I know in my office, every year someone comes out from the government. I don't know what agency they're from.

Duane Tinker: Recalibrate your machines or check the calibration.

Howard Farran: Yeah, just every year some man comes and inspects our machines. This is Dentistry Uncensored, I know that you're always supposed to support your tribe and all that stuff. I don't believe in that because I believe that if a tribe doesn't self regulate, they invite other tribes, like government, state, board, to come in and regulate for you. If we don't clean up our own act, you're just inviting another government agency to come in and regulate. The CBC stuff, it's a lot more radiation than the old pano's and bitewings. We're not talking a little bit more, it's significantly more. I think that if people are buying these CBCT's just for shits and giggles, or gonna take one on every molar root canal they do and every patient they see and all that stuff, I think 10-20 years, I think some epidemiologists are gonna tell us that was not a good idea. That's gonna invite a lot more regulation into these dental office. So in Texas, what's it like? Is it more like Missouri or more-

Duane Tinker: No, they're the opposite end of that. They're pretty ruthless in some cases. Some of those government inspectors, it's like they were picked on as children and now they're taking it out on people. I say that and heck, I used to be one of those people. That wasn't my case but really that's what it's like, respect my authority kind of thing and it can be really aggravating for the average dentist to have to deal with somebody like that when they're treating you like that in your own castle. 

Howard Farran: Yeah. So you think we might get an online CE course out of you?

Duane Tinker: Absolutely.

Howard Farran: I think that'd be a good deal. It'd be informative and it would be good marketing for you too. I think it'd be a very win-win situation. 

Duane Tinker: Certainly.

Howard Farran: Teach these guys. I know this sounds like a really, really dumb question but there are a lot of really young kids that are watching this, there might even be a sophomore in dental school. You've talked a lot about HIPAA but what's the difference between HIPAA and OSHA? What do they need to know about OSHA? You haven't really talked so much about OSHA.

Duane Tinker: OSHA is more about employee safety.

Howard Farran: It's the Occupational Safe and Healthy Administration or Act?

Duane Tinker: Yeah, it's all about employee safety. It's about incorporating a lot of infection control even though there's some difference between OSHA and infection control but they're very much a symbiotic relationship there. 

Howard Farran: Are they the same agency?

Duane Tinker: No, actually the infection control guidelines are from the CDC, which are recommendations based on scientific data. Then you've got OSHA, which are federal laws that are based in part on CDC guidelines, which are laws, which are enforceable. A lot of state agencies, state dental boards require compliance with OSHA but a lot of them also separately require compliance with CDC guidelines, so there's the difference there. When we're talking about HIPAA, that's not about the people at all. That's all about information safety and security, protecting patient privacy. 

Howard Farran: I can see why OSHA would be very serious as an agency but really shouldn't apply much to dentistry in the fact that I'll never, ever, ever forget reading on one of their websites, deaths per thousand. Construction was three per thousand per year. Agriculture was three per thousand per year. Dentistry was 0.00 per thousand per year. Then you see on the news, a crane will fall, construction, mining, that's really high risk stuff but that agency and that mindset, people die at work.

Duane Tinker: Yeah, fortunately we don't see many deaths at a dental office from an employee standpoint.

Howard Farran: If it does happen it's usually the dental assistant killing the dentist and he deserved it. What else? I still got you for eight more minutes, what else do you think you can edumacate these homies on?

Duane Tinker: It kinda goes back to HIPAA. I keep losing sleep over HIPAA stuff. There's that idea that if you come in contact with a government agency and you're respectful, there's a couple of different schools of thought. One is, hey I'm a good person so the government will take it easy on me. Or it's HIPAA forget it, I'm not gonna worry about it, it's not gonna be a problem until it is a problem. Then they're suddenly concerned about it. This is one agency that, they don't care who you are, who you made political contributions to, who you know, they'll kick your ass evenly. They hate everybody equally. This is one agency that's really got me concerned because a lot of dentists just don't see the importance or because they don't understand-

Howard Farran: Why was HIPAA created? What problem did its creators in Congress, what were they, what was their mission? What were they trying to solve?

Duane Tinker: That's like trying to ask my wife what she's thinking. I can't tell you that Howard. I know that it's original intent, I think, has been skewed. The agency that's over seeing this stuff is Office for Civil Rights, it's the same people that dealt with the civil rights issues in 1960's, the issues that we're dealing with today. They're kinda ruthless. If that's the people, I think it pays to understand the enemy if you will. Understanding their psyche and I think that speaks a lot to what's going on, what we're gonna see. 

Howard Farran: What are some of the bigger fines you've seen around the country with HIPAA?

Duane Tinker: I've seen quite a few recently for millions of dollars, multiple millions.

Howard Farran: Like how many multiple millions?

Duane Tinker: Three, four, five, 5.3, 5.5.

Howard Farran: That's more than a divorce. 

Duane Tinker: But I can't point to a single dentist at this moment and say a dentist has paid that. I think that therein lies the problem. Until it's personal, until it's a dentist, until it's a dentist in our state, in our community, most dentists are like, "You know what, I'll deal with that when it comes up or if it comes up." 

Howard Farran: On DentalTown, I would spin this in a whole different area. In DentalTown a lot of these HIPAA violations, board complaints, whatever is because you pissed off a staff or a patient. 

Duane Tinker: Right.

Howard Farran: Some of the most brutal dentists who have been thrown so under a rug, they so pissed off their associate, their dentist, their hygienist and she said, "You know what. I'm not even gonna quit and walk out. For the next ... I'm just gonna start xeroxing charts and printing out records." I mean, my God, I know this one dental assistant, the dentist was doing Sargenti and she started documenting all that. Then she went to some local endodontist who never got a referral from this guy and got them documented. Then they wanted they [inaudible 01:00:07] they called the patient, by the time it went to the board, the guy was dead before it even got there and it all happened because the arrogant dentist was pissing off staff or patients. A lot of times that's how the government finds you.

Duane Tinker: Exactly. The thing that they nail you on is not just the original problem but all of the other things that you weren't doing right or other things that you were doing wrong. They just throw it all in a basket and say, "Here you go."

Howard Farran: Let me turn that question around on you. When HIPAA knocks on the door of a dental office, why did they normally ... Was it a staff, patient, some random audit? How does HIPAA show up at your door most likely?

Duane Tinker: Well the three most common that I'm seeing today are patient complaint, OCR is now proactively auditing dental office and people, when you receive a letter from the government inform you staff, when you get a letter from the government, hit the fire alarm and let you know about it. Especially if you have multiple offices and don't get your mail per se. OCR sends out letters saying, "Hey, we're gonna do a desk audit on you." If you fail to respond to it they bump you up and say, "You know what, forget the desk audit. We're gonna come out and see you." Right now, dentists are on the radar because they're seeing that a lot of dentists have a lot of compliance issues in this area. The other thing is breach reporting.

Howard Farran: Breach reporting?

Duane Tinker: We can think we're doing everything right. We've trained our staff, we have our policies and procedures, we don't say things to people that we shouldn't and all it takes is one untrained, that new girl at the front desk. You received an email, she clicks on the email and clicks on something that now looks like a letter from one of your referring specialists in Word document. It has the logo and the signature of the dentist from that referring office in the email, it looks legit. They click on that and two days later you realize that you can't get into your computer and that you've been victimized by a ransomware situation. Now you have a reportable HIPAA breach. With that you have to-

Howard Farran: Ransomware is a reportable HIPAA breach?

Duane Tinker: If you can't determine that there's a low probability that information was compromised then yes. When that happens, according to federal law, you have to self report to the government that you had a breach. When that happens, they bring in their microscopes and look at the breach and they look at everything else that you were supposed to have to be in compliance. Whether it was related to that breach or not. They kinda do a comprehensive evaluation and that's where a lot of dentists are getting caught and where a lot of their liability is. 

Howard Farran: You say the new girl at the front desk, it's so amazing, I know a little girl who just got a job at Subway but before she did work on the first day she had to go to the computer, she had to log on. I think there was 10 different modules, each one had a test and before that girl showed up to make a tuna fish sandwich, she had training. Now, lets go to doc's office. He hires Shirley and surely he must be kidding, her day one, he just, "Here's your chair, your degree, your job was named after a piece of furniture. You are now the front desk. I'm gonna go do a root canal." She just sitting like, "Hello?" Then back to Dentrix, Eagle Soft and Open Dental, when you go to Hilton or Hyatt or the software, there's only seven things we do to check you in and with [inaudible 01:03:36] there's only six things. Then you return your rental car and Hertz has this little smartphone and there's four things they're gonna do and it's all streamlined.

Then you go up in Dentrix and Eagle Soft and they'll even tell you, you can go to the report generator, 80% of the software has never even been touched one time. She's sitting at the desk just mesmerized by 40 million bullshit buttons and doesn't even know which one of those buttons does she have to do because you should be able to go into Dentirx, Eagle Soft, Open Dental and just look at every single function. We are not gonna do that, we are not gonna do that, or they could go get some big name brand consultants like Sandy Perdu or whoever and she says, "Okay. Here's how we check them in."

Let's get rid of all that shit so that when that little girl sits at the desk, she just sees here's six things I do to check you in. Here's four things I do to check you out. Then it'd be easier to have processes that are streamlined, less employee training and then you don't miss the HIPAA thing or you don't miss, how did you find our office to find out what marketing's working. Since a telephone doesn't come into the [inaudible 01:04:51] system, you don't know what number you're calling for cause your ad on Facebook should be different than your ad in direct mail with a different number or your billboard or your monument signs. So you can say, "Oh, they called in from the number on the billboard by the highway,", "Oh they called in form this direct mail piece we did." 

Dentistry is so good at doing dentistry. They're hands on surgery in the operatory is so good and the last 30 years has gotten so much better but the business side of it hasn't even budged in 30 years.

Duane Tinker: It's suffering, right.

Howard Farran: When I was 10 years old and worked at my old man's Sonic Drive-In, he just had a cash register but it's made by National Cash Register. It had more practice management ... Like when the mean man came and delivered 10 boxes of meat for 50 patties each, you enter it in the cash register. The staff clock in and clock out on the register. The end of the day, with just a little role of paper, you could print out a report and everything my old man would show me and go over with me at 10 years old, I can't do it age 54 with my grandchildren in density. The reason is because Stan Bergman the CEO of Schein, he listened to me and he got an MBA, he sent a survey out to these dentists, a random controlled sample, asked them what my dumb ass mind thinks and they didn't agree. They said they wanted to change the color of the font and have voice activated perio and just all this bullshit and it kind of reminds me of Henry Ford. Henry Ford said, "You don't ask your market what they want." 

If Henry Ford went out there and said, "Hey, would you like to shoot your horse and eat them and buy a car?" Everybody loved their horse, they named their horse, the fed, him, combed him. When they started out with a horseless carriage they died. Henry Ford said, "They love their horse, let's take the horse out of it and let's just try to sell them on the advantage of a car." A horse can only go 20 miles a day and a model T can go 20 miles in an hour. A lot of times you have to lead your customers because your customers aren't smart enough to see where you're going. Jobs used to say that all the time. He said, "I'm not asking Americans what they think of their smartphone. They're not smart enough to know what they ... I'll tell you what your smartphone needs to do." He was right. 

That was the fastest hour ever, we're at an hour two. I hope we get an online CE course out of you. How do my homies contact you?

Duane Tinker: Contact us through our website. Like I said we have a chat function, or 817-755-0035.

Howard Farran: That's 817-755-0035, do you give out your email?

Duane Tinker: Toothcop@dentalcompliance, easy to remember.

Howard Farran: That's your name on DentalTown.

Duane Tinker: That's my name.

Howard Farran: Yeah, I love it. Hey, Tooth Cop, thank you so much for coming out to my house.

Duane Tinker: Glad to be here. Thanks for having me. 

Howard Farran: It's amazing, he lives in Dallas and I said we'll do Skype and he said, "No, I want to fly out and do it in person." Why did you do that?

Duane Tinker: Face time man, nothing beats the old fashioned face time.

Howard Farran: My God, and I got a hard face to forget. I'm sure you won't forget.

Duane Tinker: I appreciate the opportunity.

Howard Farran: Man, seriously, thank you so much buddy.

Category: dental, Podcast
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