DISCIPLINE COMMITTEE OF THE ROYAL COLLEGE OF DENTAL SURGEONS OF ONTARIO

Date: 2019-01-24

File No.: H150017

IN THE MATTER OF: A Hearing held pursuant to the provisions of the Health Professions Procedural Code which is Schedule 2 to the Regulated Health Professions Act, 1991, Statutes of Ontario, 1991, Chapter 18 (“Code”)

AND IN THE MATTER OF: the Dentistry Act and Ontario Regulation 853, Regulations of Ontario, 1993, as amended (“Dentistry Act Regulation”)

BETWEEN:

Royal College of Dental Surgeons of Ontario

-and-

Dr. Ricardo Solis

FINDING REASONS

RESTRICTION ON PUBLICATION

In the matter of the Royal College of Dental Surgeons of Ontario and Dr. Ricardo Solis the Discipline Panel ordered, under ss 45(3) of the Health Professions Procedural Code, that no person shall publish or broadcast the identity of any patients of the Registrant, or any information that could disclose the identity of any patients who are named in the Notice of Hearing and/or the Agreed Statement of Facts in this matter.

PANEL MEMBERS:

Dr. Richard Hunter, Professional Member (Chair)

Dr. William Coyne, Professional Member

Dr. Peter Delean, Professional Member

Mr. Ram Chopra, Public Member

APPEARANCES:

Ms. Marie Henein, Ms. Christine Mainville and Ms. Lauren Binhammer, for the College

Mr. Andy Cassolato and Mr. Jeffrey Koza, for Dr. Ricardo Solis

Ms. Luisa Ritacca, Independent Legal Counsel

Heard: July 20, 21, 24, 25, 27, 31, August 1, October 30, December 11, 12, 18, 19, 2017, April 17, 18, 19, 26, 27, 28, May 12, 2018, in person

Decision Date: January 24, 2019

Release of Written Reasons: January 24, 2019

REASONS FOR DECISION

This matter came on for a hearing before a panel of the Discipline Committee (the “Panel”) at the Royal College of Dental Surgeons of Ontario (the “College”) in Toronto on July 20, 2017. The matter proceeded for nineteen days over the course of several months.

THE ALLEGATIONS

The allegations against Dr. Ricardo Solis (the “Member”) were contained in the Notice of Hearing, dated November 18, 2015. The Notice of Hearing is lengthy and has not been reproduced in these reasons, but is attached as Schedule “A”. The allegations are set out in seven paragraphs. In brief, the College alleges that the Member committed an act or acts of professional misconduct in the following ways:

Contravened or failed to maintain the standards of the practice of the profession by taking unnecessary x-rays;
Recommended and/or provided an unnecessary dental service (x-rays) relative to one or more of his patients as listed in the Notice of Hearing;
Signed or issued a certificate, report or similar document that he knew or ought to have known contained a false, misleading or improper statement;
Charged excessive or unreasonable fees for various services;
Submitted an account or charge for dental services that the Member knew or ought to have known was false or misleading;
Accepted an amount in full payment of an account or charge, that was less than the full amount of the account or charge submitted to a third party payer, without making reasonable efforts to collect the balance from the patient or to obtain the written consent of the third party payer relative to one or more of his patients as listed in the Notice of Hearing; and
Engaged in conduct that having regard to all of the circumstances would reasonably be regarded by members of the profession as disgraceful, dishonourable, unprofessional or unethical, by failing to provide complete patient records to the College when requested.

The particulars for each allegation are lengthy and include references to a significant number of patients. At the outset of the hearing, the parties advised the panel that they had reached agreement with respect to certain particulars. Throughout the course of the hearing, the parties reached additional agreements, but none of the allegations were withdrawn in their entirety and the Member made no admission of professional misconduct, even where he admitted certain facts.

THE MEMBER’S PLEA

The Member denied the allegations as contained in the Notice of Hearing, but did make certain limited admissions with respect to some of the particulars. A number of those admissions were set out in an Agreed Statement of Facts, filed at the outset of the hearing, and attached here as Schedule “B”.

BACKGROUND

The Member is the owner and operator of Alcona Dental (the “Clinic”). At all relevant times and in particular, during the years covered by the College’s investigation, Dr. Solis employed one or more associate dentists and at least one dental hygienist at the Clinic.

It is the College’s position that Dr. Solis improperly accessed his patients’ insurance coverage to his and his patients’ benefit. The College alleges that Dr. Solis took x-rays that were unnecessary, submitted false and misleading claims to the insurers, billed for services not performed, billed for different services than was provided and billed insurers for one patient when the work was actually performed on another. The College alleges this was done intentionally. The College further alleges that the Member and his staff destroyed or altered records once it became clear to them that the College investigator had uncovered their scheme.

The Member denies that he or his staff did anything to intentionally mislead or take advantage of his patients’ insurance coverage. Dr. Solis submits that he did not perform unnecessary dental procedures (i.e. x-rays) or purposely bill for services not performed or bill one patient for another patient’s dental work. If there are accounting errors, Dr. Solis submits that they are simply that and he did not direct his office staff to undertake any irregular or inappropriate billing practices. Dr. Solis further submits that many of the concerns raised by the College relate to services rendered by one of his associates, when Dr. Solis was not even present at the Clinic.

ISSUES

This case raises five primary issues:

Did the Member engage in professional misconduct in relation to the taking of x-rays? (Allegations 1 and 2)
Did the Member engage in professional misconduct in relation to his billing practices? In particular, did he submit an account that he knew or ought to have known was false and/or did he issue a report or similar document that he knew contained false and/or misleading information? (Allegations 3 and 5)
Did the Member engage in professional misconduct in relation to billing for services not performed? (Allegation 4)
Did the Member fail to collect or attempt to collect co-pays from one or more of his patients? If so, did that amount to professional misconduct? (Allegation 6)
Did the Member destroy or alter medical records and/or fail to provide medical records to the College as required? If so, did such conduct amount to professional misconduct? (Allegation 7)

Evidence Considered

The panel heard testimony from eleven witnesses, including a number of former employees of the Clinic, the College Investigator, the Member, his wife, the current office manager and two current patients.

In addition, the panel was provided with a number of patient records, x-rays and other documents.

As will be clear from the panel’s reasons below, the documentary evidence was extremely thorough and in most instances provided the panel with the evidence it required to assess the various allegations. While the panel considered the evidence of the witnesses called by both the College and the Member, that evidence was less helpful than the patient records themselves. In the circumstances, the panel did not find it necessary to conduct an in depth consideration of the reliability or credibility of each of the witnesses.

The panel noted that there were a number of the College’s fact witnesses who appeared to have difficulty remembering what happened during the relevant time period, which made it difficult to accept their evidence. Where possible, the panel based its decision exclusively on the documents presented and did not place significant weight on the evidence of the Member’s former employees.

It should be made clear, however, that the panel did consider the Member’s evidence and in particular his explanation for the various records and billing discrepancies.

The Law and Legal Principles

Burden and Standard of Proof

The College bears the burden of proving the allegations as against the Member. The College must do so on the civil standard of proof, which is proof on a balance of probabilities. (F.H. v McDougall, 2008 SCC 53). Put another way, the College must establish that it is more likely than not that the alleged conduct occurred.

The Court further provided that the burden of proof does not change depending on the seriousness of the case:

In my view, the only practical way in which to reach a factual conclusion in a civil case is to decide whether it is more likely than not that the event occurred. To suggest that depending upon the seriousness, the evidence in the civil case must be scrutinized with greater care implies that in less serious cases the evidence need not be scrutinized with such care. I think it is inappropriate to say that there are legally recognized different levels of scrutiny of the evidence depending on the seriousness of the case. There is only one legal rule and that is in all cases, evidence must be scrutinized with care by the trial judge. Similarly, evidence must always be sufficiently clear, convincing and cogent to satisfy the balance of probabilities test. (McDougall, paragraphs 44-46, 48)

The panel recognizes that it is the College’s burden to prove the allegations to the requisite standard. There is no obligation on the Member to disprove the allegations.

DECISION

For the reasons that follow, the panel finds that the Member engaged in professional misconduct as alleged in the Notice of Hearing.

While the panel did not make findings in connection with each particular, it is satisfied that the College has established on a balance of probabilities that the Member engaged in professional misconduct as described in the Notice of Hearing. In particular, the panel finds that the Member:

In certain instances, recommended and/or took excessive and/or unnecessary x-rays;
Billed insurers for services not performed;
Billed insurers under one patient name, for services performed on another patient;
Failed to collect or attempt to collect co-pays from patients; and
Failed to provide the College with complete patient records as requested.

SUMMARY OF FACTUAL FINDINGS

Allegation 1 & 2 Unnecessary X-Rays

Allegation 1: Failure to Maintain the Standards of the Profession

Allegation 2: Recommending or Providing an Unnecessary Dental Service

The College alleges that Dr. Solis committed professional misconduct by taking x-rays too frequently, without justification and by taking an x-ray that was outside the scope of a dental practice (i.e. an x-ray of a patient’s wrist).

It is uncontroversial that in fact, Dr. Solis did take an x-ray of Patient S.I.’s healing fractured wrist. Radiographs of wrists are not considered within the scope of a dentist’s practice and as such the Member was wrong to do so.

In support of these allegations, the College filed a number of patient records, which revealed instances where Dr. Solis ordered x-rays, in the absence of a clearly set out reason to do so. There were either no notes or insufficient notes to properly assess whether Dr. Solis had appropriately considered whether the x-rays as ordered were justified in each instance.

The RCDSO Guidelines (Exhibit 6) and ADA Guidelines (Exhibits 5 & 55) clearly specify that the number and frequency of radiographs (i.e. x-rays) taken on a patient must reflect a balance between keeping the number of exposures to a minimum while obtaining an adequate number of radiographs for a complete diagnosis. Radiographs should never be prescribed based on inflexible time periods or on whether they are covered by the patient’s insurer. The records filed with the panel do not demonstrate whether the Member in fact undertook the balancing required by the Guidelines. In the absence of clear records, the panel finds that the Member failed to maintain the standards of the profession and in a number of instances recommended or provided unnecessary dental services. Below, the panel has summarized its findings on a per patient basis:

Patient

Records

Finding

BA is a 13-year old patient. The records indicated that she received 1 panoramic and 8 bitewing radiographs between February 8 and March 5, 2012. There are no dentist or hygiene notes recorded to justify why these x-rays were taken.

Absent a justification in the records, the number of x-rays taken for this patient is not reasonable.

CB had 17 x-rays taken in a seven month period between July 2008 and February 2009.

There are no clinical notes available to justify why these x-rays were taken and no notes recording the findings from the x-rays.

Further on June 10, 2013, two bitewings and 2 periapical x-rays were taken. Dr. Solis’ explanation for doing so was so that he could check his associate’s work. The previous x-rays taken by the associate were available in the file.

There was a total of 10 bitewings x-rays taken between February 2012 and June 2013.

There was no justification in the records for the number of x-rays taken for this patient.

The number taken between 2012 and 2013 were clearly excessive.

SC1

Two bitewing, two periapical and a Panoramic x-rays were taken of this patient on April 30, 2013. As per ADA Guidelines, the ordinary practice is for one or the other type of x-ray to be taken, but not both (Periapical or Panoramic).

Approximately 6 months later, on November 6, 2013, another two bitewings and two periapical x-rays were taken.

Another two bitewings and 2 periapical x-rays were taken on May 7, 2014. The records indicate that on his initial check, Dr. Solis noted improvement in the patient’s periodontal condition.

According to the ADA Guidelines, either bitewings or a panoramic film should be taken.

A six month interval is not an acceptable means of monitoring a periodontal condition, and it is particularly unusual to order this number of x-rays where improvement is noted.

SC2

In a thirty-four month period, twelve bitewings, eleven periapicals and two panoramic x-rays were taken on this patient. The member explained that this was done to monitor the patient’s periodontal condition.

The number of x-rays taken of this patient was excessive and not justified in the patient records.

The primary method of assessing a patient’s periodontal condition is through periodontal probing and not by taking repeated x-rays.

This patient was approximately 16-years old during the relevant time period. Ten bitewing x-rays and one panoramic x-ray were taken during a 12-month period (February 27, 2012 to March 7, 2013)

There was no justification in the records for taking this number of x-rays from a young, low risk patient.

In the span of six months (2009- 2010), there were six bitewing x-rays and ten periapical x-rays taken from this patient.

On April 23, 2013, another two bitewings, two periapical and one panoramic x-rays were taken.

Similarly, two panoramic x-rays were taken within two to three months of each other in Spring 2014.

There was nothing in the patient’s records to justify the need to take so many x-rays in a six month interval.

There was nothing in the patient’s record to justify the need to take these x-rays in 2013.

Dr. Solis acknowledged that the second panoramic should not have been taken.

Four bitewing x-rays were taken of this patient within a six month period. There is no explanation in his records for the decision to do so.

There was nothing in the patient’s record to justify the need for this number of x-rays in the six month interval.

Two or more bitewing x-rays were taken of this patient every year from September 2007 to March 2012. There is nothing in the records to explain the reason for the x-rays.

There was nothing in the patient’s record to justify the x-rays taken.

CS3

The patient had two bitewing x-rays taken at six month intervals from August 2011 to February 2012 and again in March and September 2013.

There was nothing in the patient’s record to explain why bitewing x-rays needed to be taken every six months.

The patient had two bitewing and two periapical x-rays taken within a 10-month period.

There is a notation in the record indicating that the patient did not want any treatments unless he was in pain.

There was nothing in the patient’s record to explain the need for this number of x-rays to be taken within a 10-month period.

The patient had two bite wings and periapical x-ray taken on February 5, 2013. Hygiene notes only mention one periapical being taken.

Further, the patient had two bite wings and 2 periapical x-rays taken on November 6, 2013. The proposed reason for these x-rays was to check for bone height and caries yet no periodontal probing was performed and there were no notes specific to the absence or presence of caries.

There is no justification in the clinical notes for these x-rays.

This patient had the same x-rays taken seven months apart.

This patient was suffering with brain cancer at the time and undergoing chemotherapy. There is nothing in the patient record to explain why this seemingly low risk patient would require repeat x-rays.

There is no justification in the clinical notes for these x-rays.

This patient received two bitewing x-rays every year (June 10, 2009, April 7, 2010 and February 23, 2011) for 3 years without any notation as to why they were taken.

There is no justification in the clinical notes for these x-rays.

Allegations 3 & 5: False or Misleading Statements and Accounts

Exams Not Provided

The patient records filed revealed that with respect to at least three patients, it appears that the Member billed for examinations that were not in fact provided. The records reveal that work was done on one patient, but billed to a family member’s insurer.

BG & LG: The records confirm that dental services were provided to LG but the claim to the insurance company was submitted under the name of her husband, BG.

The records revealed that by October 2012, LG had reached her maximum insurance coverage for the year. Further, the records show that LG attended at the Member’s office for an appointment and that the claim form submitted for the work done was submitted under BG’s name. The records further reveal that BG did not attend for an appointment in November 2012.

The inference to be drawn from this evidence is that LG’s dental services were billed on BG’s insurance because LG had run out of coverage by October 2012.

SC1 & SC2: In or about July 2012, records indicate that SC1 received dental services, but a claim was submitted under his wife’s name. The records indicate that he received a 37 MO restoration, for which he was not billed. Instead, SC2’s insurer was billed for the very same restoration.

Similarly, there are notes in SC1’s records indicating that he attended for a hygiene appointment in July 2012, where he had scaling done and where two bitewing x-rays were taken. These services do not appear to be billed to SC1 or his insurer. Instead SC2 was billed for hygiene and x-rays in July 2012, but there are no notes in her record to indicate that she received any such service.

The records confirm that SC1 had met his insurance coverage maximum by July 2012. The inference to be drawn from this evidence is that SC1’s dental services were billed on SC2’s insurance because SC1 had run out of coverage by July 2012.

TI & JI: According to the records, on October 23, 2013 Dr. Solis provided services to JI but submitted claims for those services under the name of his mother. TI’s insurer was billed for a panoramic radiograph. No panoramic x-ray for TI was provided to the College, but a panoramic x-ray taken of JI on October 23, 2013 was provided. JI was not billed.

The inference to be drawn from this evidence is that TI’s insurer was billed for dental work done on her son.

Submitted Claims for Dental Services that were not Provided

Claims for Examinations

The College produced records to indicate that on numerous occasions, the Member billed for dental services that do not appear to have been provided. The panel was presented with overwhelming evidence to show that there were little or no records to support the billing in these instances. Where the notes do not confirm that the service was provided, the panel has found as a fact that the services were not provided. This is not a situation where in a few instances, the records do not clearly set out the services provided. In the numerous instances summarized below, there are simply no or deficient records to support the claims for services made by the Member’s office.

CB: On June 10, 2013, the patient’s insurer was charged for dental services, including a complete examination. There are no notes from Dr. Solis in the record to confirm that a complete examination was performed. An appointment requisition form confirms that the patient attended on the day in question for a recall examination, which is different from a complete examination. The billing codes for each type of examination is different.

Further, the hygienist’s notes make no reference to a complete examination having taken place and it appears that the amount of time scheduled for the appointment would not have permitted a complete examination to have taken place.

On January 28, 2014, the patient’s insurer was charged for a recall exam and other dental services. The hygiene notes on file make no mention of a dentist having come in to perform any type of exam on the patient. Instead, the notes indicate that the hygienist would show Dr. Solis the patient’s x-rays and provide him with an update on the patient’s gingival and periodontal status. The appointment calendar shows that Dr. Solis was out of the office for the entire day, and there were no dentist’s notes to confirm that a recall exam was performed.

BC: On May 21, 2013, the patient’s insurer was billed for a specific examination. BC is not listed in the appointment calendar and there are no hygiene or doctor notes to confirm that this exam was performed.

On August 19, 2013, a claim was submitted to the patient’s insurer for a periodontal re-evaluation that does not appear to have been performed. The hygiene notes do not say that a dentist performed a periodontal re-evaluation on this patient. While it appears that the hygienist placed a check-mark beside “perio re-eval” on a preprinted form, there are no notes in the patient’s record to indicate that the dentist in fact performed a periodontal re-evaluation.

On November 14, 2013, a claim was once again submitted to the patient’s insurer for a periodontal re-evaluation. There are no dentist’s notes to confirm whether such an evaluation took place and there is nothing in the hygiene notes to indicate that a dentist was present for the evaluation. Although the hygienist may have done her own assessment a dentist is required to do a periodontal re-evaluation.

WC: On February 19, 2013, a claim was submitted to the patient’s insurer for a recall examination. There are no dentist or hygiene notes for this date to confirm whether such an examination took place or even whether the patient attended the Member’s office at all.

BF: An insurance claim was submitted on February 16, 2012 for a periodontal re-evaluation for this patient. The hygiene notes do not indicate that such an evaluation took place. Instead, the notes indicate that the patient attended for a periodontal scaling. There was no updated periodontal charting found in the notes for this date, and the appointment calendar suggests that no dentist was present when BF was seen. This patient was more likely seen by a hygienist and not a dentist, despite what was submitted to the insurer.

KG: A claim for a periodontal re-evaluation was made on February 1, 2012. There is nothing in the hygiene notes to indicate that a periodontal re-evaluation was performed by a dentist. Instead, the notes are consistent with the visit being a 3-month recall appointment.

LG: On January 5, 2009 a claim was submitted to the patient’s insurer for a recall exam. Hygiene notes do not indicate that a recall exam was performed by a dentist. There are no doctor’s notes indicating an exam was performed at all. Although local anesthetic administration was performed by Dr. Solis it does not confirm that an exam was also performed.

KI: On May 7, 2007 Dr. Solis was the attending dentist. A claim was submitted under this patient’s name for panoramic and cephalometric x-rays, but no x-rays were provided to the College and there is no mention of taking x-rays in the Member’s notes.

On December 1, 2008 the patient’s insurer was billed for two bitewing radiographs, hygiene treatment, polish and fluoride. There are no progress or hygiene notes available for this date. The appointment requisition form indicates that the patient’s December 1st appointment was in fact cancelled. There is nothing to suggest that it was rescheduled.

Similarly, on June 15, 2009 the patient’s insurer was billed for fluoride treatment. She was seen by Joanne Evenden the hygienist, who had no specific recollection if she provided a fluoride treatment and her notes did not indicate it was in fact provided.

ML: On June 19, 2013 a claim was submitted to the patient’s insurer for a specific exam. There are no hygiene or dentist notes for this date. An appointment requisition form indicates that this appointment was for a crown insert and Dr. Solis’s notes from the previous appointment also state that the next visit would be for a crown insert. The panel does not accept that a specific exam was performed on this date.

VR: On January 26, 2008 a claim was submitted to the patient’s insurer for a limited examination as well as other hygiene services. Hygiene notes do not confirm that an exam was performed and there are no dentist notes to support the billing.

BS: On January 13, 2011 a claim for an examination was submitted to the patient’s insurer. There are no hygiene or dentist notes for this date. There is simply nothing in the file to confirm that the patient received any care on the date in question.

Similarly, on December 6, 2011 a claim for an examination was submitted to the patient’s insurer. There are no hygiene or dentist notes to confirm the examination took place. According to the appointment calendar, the patient was booked to see Dr. Solis as his last patient for the day. The booking was scheduled for a 30-minute appointment. The insurer was billed for one hour’s worth of services.

Finally, on February 29, 2012 a claim was submitted to the patient’s insurer for a specific examination, two periapical x-rays and two units of scaling. The two periapical x-rays were not provided to the College and so there is no evidence before the panel to confirm that they were in fact taken. Further, there are no hygiene or dentist notes to confirm that this patient attended on February 29th and in fact his name does not appear on the appointment calendar for that date.

CS1: On February 29, 2012 a claim was submitted to the patient’s insurer for an examination as well as other dental services. There are no hygiene or dentist notes to confirm any of these procedures actually took place. Further, the patient does not appear in the appointment calendar.

In addition, on August 8, 2012 a claim was submitted to the patient’s insurer for a recall examination, two bite wing x-rays, two periapical x-rays, polish, scale and fluoride. The hygiene notes do not confirm that a dentist performed any dental services on this patient. The patient was only scheduled for a 45-minute appointment with the hygienist, which would likely not have been enough time to complete all the services that were billed.

AS: On May 30, 2012 a claim was submitted to the patient’s insurer for a periodontal re-evaluation. The hygiene notes do not indicate that such a re-evaluation was done by a dentist. The notes seem to indicate that the patient received a 3-month recall check, and not a periodontal re-evaluation, which is a longer and much more extensive examination.

JT: On May 2, 2011 a claim was submitted to the patient’s insurer for an examination. There are no notes in the records provided to confirm that any such examination took place. Although Dr. Solis thought this patient might have seen Dr. Trotti, the appointment schedule says “Dr. S will be here”.

RT: On April 11, 2012 a claim was submitted to the patient’s insurer for an examination, two periapical x-rays, four bitewing x-rays, polish, three units of scaling and fluoride. None of the x-rays billed were found in the patient’s file. There were no notes to indicate that the patient even attended the office that day and the appointment calendar indicates that both Dr. Solis and his hygienist were fully booked with other patients.

SW1: On May 3, 2011 a claim was submitted to the patient’s insurer for a periodontal re-evaluation. Hygiene notes do not confirm that a periodontal re-evaluation took place. The notes refer to the treatment being planned by Dr. Solis, but not that any such treatment took place. Dr. Solis testified that he thought his associate might have seen SW1 but SW1 testified that he only saw Dr. Solis.

Similarly, on November 2, 2011 a claim was submitted for a periodontal re-evaluation. Hygiene notes do not confirm that a periodontal re-evaluation took place. There are no notes from the dentist on file.

SW1: On March 3, 2010, a claim for a complete examination was submitted to the patient’s insurer. The records indicate that the patient attended on March 3rd for a recall examination instead. There is nothing in the records to support the submission of a claim for a complete examination in the circumstances and the panel rejects Dr. Solis’s premise that the actual bills generated are the most accurate documents with respect to work actually done. The bills are not included in the patient’s files. The medical notes are to be used to record the patient’s health and the various procedures done and observations made during the course of treatment.

SW2: On January 25, 2011 a claim was submitted to the patient’s insurer for a recall examination. The patient’s appointment was booked at 4:30 pm when, according to the appointment calendar neither Dr. Solis or his associate, Dr. Trotti, were present. The hygiene notes record “DMD (Dr. Solis) to check”, but there is nothing in the records to confirm that the patient was in fact seen by a dentist at all.

GY: On or about November 24 and 28, 2011 a claim for an examination was submitted to the patient’s insurer. There are no notes to substantiate than an examination took place by a dentist.

Various Services not provided to SC2 and Her Family

SC2 [redacted]. She testified on the Member’s behalf at the hearing. While her evidence was wholly supportive of Dr. Solis, she could not explain the billing issues identified by the College from a review of her family’s dental records. Much like the records for other patients, there were numerous instances in her family’s records wherein her insurer was billed for services for which there is no record that they were provided. On March 21, 2012, SC2’s insurer was billed for a recall exam, oral hygiene instruction, x-rays, scaling, polish and fluoride treatment. Dr. Solis was the only dentist in the office on that date. There are no hygiene or progress notes for this visit and the x-rays billed were not in the file and could not be located.

On September 24, 2012 this patient’s insurer was billed for a recall exam, oral hygiene instruction, x-rays, scaling, polishing and fluoride treatment. SC2’s name does not appear on the appointment schedule and the hygienist is fully booked with other patients. Further, there are no dentist or hygiene notes for this date and the x-rays billed were not in the file and could not be located.

On February 19, 2013 a claim was submitted to this patient’s insurer for a specific exam by Dr. Solis. There are no dentist or hygiene notes for this date. The appointment does not appear on the appointment requisition sheet.

Finally, on June 3, 2013 desensitization was billed to SC2’s insurer by Dr. Solis. The notes on file do not indicate that desensitization was in fact provided.

The allegations related to January 6, 2011, August 11, 2011, September 8, 2011 and January 8, 2013 result from billings on days when it appears that the Member’s associate was in the office. In the circumstances, it is not clear which dentist was responsible for treating the patient. As a result, the panel makes no findings of fact against the Member for these specific dates.

DM is SC2’s son. This patient’s insurer was billed on May 7, 2013 for a recall examination, oral hygiene instruction, radiographs, scaling, polishing, fluoride and desensitization. There are no dentist or hygiene notes for this date. The radiographs billed for this date are not in the file. DM was not listed in the appointment calendar and this particular appointment does not appear on the patient’s appointment requisition sheet.

On July 4, 2012 claims were submitted to this patient’s insurer for a periodontal re-evaluation, oral hygiene instruction, scaling and desensitization. There are no dentist or hygiene notes for this date. The appointment requisition form from May 2012 states that the patient’s next visit was for November 2012, not July 2012.

SC1 is SC2’s husband. On October 6, 2010 this patient was billed for periodontal irrigation. There are no hygiene notes to confirm that this procedure was performed. In fact, the notes state that the gingiva was firm and pink with no bleeding points, suggesting that irrigation would not have been necessary.

The allegations relating to September 9, 2010, January 17/20, 2011, September 19, 2011, March 12, 2012 and March 20, 2012 result from billings on days when the associate was in the office. It is not clear which dentist was responsible for treating the patient. As a result, the panel makes no findings against the member.

Claims for Gingivectomies Not Performed

The records reveal that at least with respect to two different patients, insurance companies were billed for gingivectomies that were not in fact performed. The panel notes that there were no notations in the records reviewed describing the procedure at all. This is unusual in that you would expect to see detailed notes for this sort of procedure.

In the case of GL, his insurer was billed for a gingivectomy following an appointment on March 10, 2011. The records indicate, however, that the patient attended the office for teeth whitening. The treating hygienist testified that she remembered providing the patient with teeth whitening and neither the Member nor Dr. Trotti, his associate, remembered performing a gingivectomy on this patient.

Similarly, patient TB3’s insurer was billed for a gingivectomy on October 6, 2009. The patient’s records were not available to the College, but the appointment schedule indicates that the patient was present for a “crown prep”. While Dr. Solis testified that he remembered performing a gingivectomy on this patient, the information in the appointment schedule indicates otherwise.

The allegations related to AB on March 3, 2011 and KL on March 7, 2011 result from billings on days when the associate was in the office. It is not clear which dentist was responsible for treating the patient. As a result, the panel makes no findings against the member.

Claims for X-Rays

The panel received a number of records confirming that the Member’s patients were billed for x-rays which were not in the patients’ file and which have never been provided to the College for verification. In the circumstances and given the number of instances where x-rays were billed, but are missing, the panel finds that the x-rays were not taken as billed. In particular, the panel finds that the following patients’ insurers were billed for x-rays which were not taken:

Patient

Date X-Rays Billed

February 12, 2009; March 17, 2011

TB3

June 4, 2009; January 26, 2011

August 27, 2012

November 14, 2012

October 29, 2013

May 25, 2011

December 6, 2011; February 29, 2012

January 13, 2011

April 11, 2012

The following list patients were treated and billed on days when the associate was in the office. It is not clear which dentist was responsible for treating the patient although the billing was in Dr. Solis’s name.

BA – March 5, 2012

AB – September 29, 2011

TB3 – July 28, 2011, October 31, 2011

TB3 – March 5, 2012

DC – August 27, 2012

BC – March 31 or April 4, 2011

BG – March 22, 2011

LG – May 24, 2011

LG – April 2, 2012

MK – July 27, 2010

GL – February 27 or 28, 2012

KL – August 16, 2011

DP – October 25, 2010

PT – September 18, 2012

GT – April 30, 2012

In the circumstances, the panel makes no findings with respect to these specific patient x-rays.

The following list of patients and dates are days when an associate is present in the office providing treatment. The lack of dentist’s notes precludes the panel from determining who was responsible for attending to the patient and as such the panel makes no findings with respect to these patients.

DC – On August 27, 2012

LG – April 2, 2012

BC – February 6, 2013

RJ – March 19, 2012

LL – April 5, 2012

BC – March 31 or April 4, 2011

SW2: The allegation of misconduct on June 11, 2013 occurred on an associate (Dr. Mason) day. It is not likely that the claimed services were provided by Dr. Solis. The panel makes no findings against the member.

Claims for Local Anesthetic in Conjunction with Scaling

The records indicate that with respect to at least 18 patients, Dr. Solis made a claim to his patients’ insurers for the administration of local anesthetic when performing scaling. The Ontario Dental Association (ODA) Fee Guide makes clear that dentists cannot charge for local anesthetic when performing operative or surgical procedures. As set out in the ODA Practice Management article filed with the panel, scaling is an operative procedure and as a result the administration of local anesthetic when performing scaling is not a billable procedure.

Dr. Solis acknowledged that the majority of the patients were treated by him. The panel finds that he is responsible for the erroneous billing connected to the patients under his care whose insurers were billed for both scaling and local anesthetic.

Dental Services Billed in Place of Other Services

SC1:

In addition to the claims for gingivectomies which were not performed as described above, the Member’s records revealed that on several other occasions, the Member’s office staff would bill insurers for services not performed in place of services actually completed. As described above, SC1 received whitening treatment which was billed to the insurer as a gingivectomy in October 2010.

Similarly, in April 2012, the records indicate that SC1’s insurer was billed for a flap approach with ostectomy and tooth color restorations. There are no dental notes relating to a surgery or restorations. The records do, however, include a lab prescription dated April 4, 2012 for veneers for this patient. The panel heard from various front desk employees who confirmed that SC1 received veneers. Given the testimony from the front desk employees and based on the records, the panel finds that SC1 received veneers instead of tooth coloured restorations in conjunction with a surgical flap and ostectomy, which was billed to his insurer.

SC2:

SC2’s insurer was billed on March 24, 2011 for a gingivectomy. The appointment calendar records that SC2 attended for scaling and whitening. The hygiene notes do not mention a gingivectomy and she was not billed for anything other than the gingivectomy. The patient testified that Dr. Solis popped in while she was getting her teeth cleaned and decided to do a quick gingivectomy. The panel had difficulty accepting that this patient would have even know what a gingivectomy is. [redacted] had no dental experience. Even Dr. Solis testified he thought hygienists could perform this procedure. A gingivectomy is a surgical procedure which can be performed by only a dentist. Also, the patient’s evidence does not accord with the records. The panel does not accept the patient’s evidence with respect to this visit. [redacted] Her description of the services is unreasonable and not in line with the records, which make no mention of a gingivectomy. Further, the patient’s evidence does not provide an answer for why she or her insurer was not billed for the other services performed at that appointment.

TS:

Finally, the billing records suggest that TS attended appointments with Dr. Solis on November 7 and 14, 2012. On November 7th, TS’s insurer was billed for an emergency examination and desensitization. On November 8th, her insurer was billed for a recall examination, x-rays, scaling, polish and oral hygiene instruction. There are no dentist or hygiene notes for the emergency examination, desensitization or recall appointment. There is a note dated November 17, 2012 stating that the patient had bleaching (whitening). The patient is not on the appointment calendar on November 7 or 14, 2012. There is a note in her file from May 2015 that indicates that the patient had previously received whitening. It appears that the patient was never billed for teeth whitening.

Claims with Incorrect Dates for Service

The panel received records to indicate that with respect to patients CB, BC, KI and SI, the Member filed claims with insurers listing the incorrect date for the services provided. In certain instances, the claims were made before the treatment was provided and in other instances, the claims were made well after.

BA – December 21, 2010

TB2 – December 22, 2010

BC – March 31, 2011

LG – December 12, 2011 and September 2012

TM – July 2012

Claims for Periapical X-rays when Bite Wings Taken:

The panel reviewed records which established that with respect to at least eight patients, insurance claims were made for periapical x-rays, when only bitewing x-rays were in fact taken of the patients. The records made clear that Dr. Solis was present in the office during the appointment times. Below is a list of the patients and a brief description of the billing discrepancy.

Patient

Description of Discrepancy

On November 26, 2012, the patient’s insurer was billed for two bitewing x-rays and two periapical x-rays. The records indicate that in fact four bitewings were taken and no periapical x-rays.

On April 30, 2012, the patient’s insurer was billed for two bite wings and two periapical x-rays. There were no periapical x-rays on file or provided to the College. The records indicate that in fact four bitewing x-rays were taken that day.

On March 22, 2011, the patient’s insurer was billed for two bitewing and two periapical x-rays. It appears from the x-ray records and the hygienist’s notes that in fact four bitewing x-rays were taken and no periapicals.

CS3

On March 6, 2013, two bitewing x-rays and one panoramic x-ray were taken of the patient. Those x-rays were in the file and made available to the College. However, it appears that for the purposes of billing, the patient’s insurer was billed for periapical x-rays, even though none appear to have been taken that day.

On March 26, 2013, a claim was submitted for two bite wing and two periapical x-rays. Four bite wing x-rays were in the patient’s file and were provided to the College. There were no periapical x-rays matching the patient’s March 26, 2013 billing.

The patient’s insurer was billed for two bite wings and two periapical x-rays on May 2, 2011. There were no periapical x-rays in the patient’s file and in fact the file contained and the College was provided with four bitewing x-rays instead.

Similarly, on December 2, 2013, a claim was made for four periapical x-rays. It appears from the records, however, that only two bitewing and two periapical x-rays were in fact taken of this patient. This is consistent with the x-rays provided to the College and with the hygiene notes on file.

On May 7, 2013, the patient’s insurer was billed for two periapical x-rays. There were no such x-rays in the patient’s file for May 2013. However, there were two bitewing x-rays in the file for May 7th, and the hygienist’s notes confirm that two bitewings were taken.

The records revealed several other instances where the wrong type of x-ray was billed to the patients’ insurers. Where it was clear in the record that Dr. Solis’ associate was the treating dentist, the panel makes no findings against the Member.

With respect to patients, SI and CS, the Member admitted that the wrong billing codes were entered for the x-rays taken of these patients on March 26, 2007 and August 8, 2012, respectively.

CB – February 13, 2012

DC – February 23, 2012

SC2 – May 19, 2011

BF – August 20, 2012

BG – October 6, 2011

BG – May 14, 2012

LI – November 6, 2012

KI – February 14, 2011

KI – August 22, 2011

KI – September 6, 2012

ML – July 19, 2011

ML – July 17, 2012

DM – May 7, 2012

SN – September 15, 2011

DP – October 25, 2010

Allegation 4: Charging Excessive or Unreasonable Fees

These allegations overlap with Allegations 3 and 5 which have been dealt with above. Where the panel has found instances of billing discrepancies, it found that those discrepancies resulted in a charge of an excessive or unreasonable fee. The records reviewed and summarized above, indicate that the Member’s billing practices resulted in excessive charges for treatment not performed and/or not insurable. In addition to the patient treatments and charges discussed above, the panel found that the following charges were excessive and unreasonable in the circumstances.

Patient

Summary of Excessive Charge

SW1

On March 3, 2010, the patient’s insurer was charged for a complete examination, where only a recall examination was performed.

Claims totaling $1900 for orthodontic treatments were submitted in 2007 and 2008 for this patient. The only notes from those dates state that Dr. Solis proceeded with an orthodontic evaluation on May 7, 2007. There are scant notes regarding the proposed treatment (Exhibit 4, Vol. 3, Tab 23A, p. 1770). There is reference to KI receiving a Hawley appliance in April 2007, but there are no other records indicating any other orthodontic treatment was provided that would justify the fees charged.

There is another excessive charge allegation with respect to this patient for February 12, 2012. The records indicate, however that Dr. Trotti was the attending dentist for that appointment. As such, the panel makes no finding against the Member with respect to this particular entry.

Allegation 6: Failure to Collect Co-Pays

The College alleges that Dr. Solis failed to collect co-payments or deductibles from patients, did not make reasonable efforts to collect these co-pays and deductibles, and did not have the insurer’s consent not to collect.

Robin Viera, Eileen Murphy and Monica Alves who were front desk staff, all testified that Dr. or Mrs. Solis did not want to collect co-pays from family, friends and older patients. When SC [redacted] the policy changed and they began collecting co-payments. This was confirmed by Rhonda Scott.

The records indicate that with respect to four patients (AB, KI, JJ, and BS) the Member failed to collect co-payments or failed to make any effort to do so. The Member argued that with respect to BS, his mother provided cleaning services to the office in exchange for a waiver of the co-payment. There was no evidence before the panel confirming this arrangement. None of the other witnesses were able to confirm the arrangement and BS’ mother was not called to testify.

Allegation 7: Failure to Provide Records to the College

The College alleges that Dr. Solis engaged in conduct or performed an act or acts that having regard to all circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable, unprofessional or unethical. The basis of this allegation is Dr. Solis’s failure to provide the College with complete records for fourteen patients, whose records were requested by the College.

The Member did not contest that part of the records for these fourteen patients were sought and not received by the College.

REASONS FOR DECISION

Allegations 1 & 2 – Excessive X-rays

Dr. Solis’ patient records reveal that he failed to maintain the standards of practice by taking unnecessary x-rays and in one instance, taking an x-ray outside of the scope of dentistry. The RCDSO (Exhibit 6) and the ADA Guidelines (Exhibit 5 and 55) specify that a balance between minimizing the number of radiation exposures and obtaining an adequate number of x-rays for a complete diagnosis is the goal when examining a patient. The type and frequency of x-rays should be based on the individual patient’s clinical signs, symptoms and past dental history. They should not be prescribed based on inflexible time intervals.

It was evident from the records that the Member did not conduct an individual assessment of the appropriateness of taking x-rays on a patient by patient basis. For the most part there was nothing or very little in the clinical notes to support the x-rays ordered. In most cases, there were no notes from the Member or his hygienist to explain why the x-rays were taken or whether any sort of disease or condition was found. The panel was not prepared to simply rely on the Member’s memory of why he believed the x-rays were necessary in each case. The clinical notes must reveal the rationale for the x-rays. Where they do not, the panel could only conclude that the Member failed to follow the College and ADA Guidelines in balancing the need for the x-rays with the desire to minimize radiation exposure for the patient. It was apparent from the records that most of the patients received x-rays on an inflexible time period. That is to say, if their insurance covered a specific type of radiograph every six months the patient would have those x-rays taken in that time frame without justification.

Allegations 3 & 5: False or Misleading Statements and Accounts

Allegation 3 and 5 related to a variety of billing discrepancies. As described above, the Member’s records reveal a pattern of problematic and false billing, when taken in totality establish that the Member engaged in billing practices that he knew or ought to have known contained false and misleading information. It appears this was done to maximize recovery from the patients’ insurers.

A. Submitted Claims for One Patient Under the Name of Another

As discussed above, the records established that on more than one occasion, a patient’s insurer was charged for treatment performed on another patient. The information in the records was corroborated by two former front desk staff who testified and were able to recall that they processed billings for one family member under the name of another family member.

For example, Eileen Murphy testified that the office staff would sometimes bill services that were provided to AB under her husband’s name and vice versa, if one had run out of benefits for the year. She also testified that Dr. Solis provided a lot of work for AB’s nephew, who did not have insurance. The office staff were instructed to bill the work performed on him under AB’s and TB3’s names.

Similarly, Rhonda Scott testified that services provided to SC1 were billed under his stepson’s name and services provided to LG were billed under her husband’s name for insurance purposes.

B. Submitted Claims for Dental Services that were not provided

The panel concluded that if a claim was submitted for a service or treatment that was not supported by the clinical notes or records, then the only inference to be drawn was that the service was not provided as billed. Maintaining complete and accurate records is a key component of any professional’s practice and the lack of documented evidence to support the numerous insurance claims weighed heavily on the panel’s decision.

Claims for Examinations

Upon review of the patient records and upon hearing from several former employees, it was clear to the panel that in many instances examinations were billed to insurers, but were not in fact provided. The panel was satisfied that this problematic conduct was systemic for several years. The testimony of the various staff members with respect to this issue was credible and consistent with the clinical notes and billing records.

Various Services Not Provided to SC2

Dr. Solis was the primary provider of services to SC2. Dr. Trotti testified that SC2 preferred to see Dr. Solis and so at a minimum he would have been involved closely with her care. He therefore knew or ought to have known that services were being billed to her insurer that were not in fact provided. SC2’s insurance was billed for a number of services – from hygiene, to exams – of which there is absolutely no record; no notes or x-rays on file. Dr. Solis must have noticed that there were gaps in SC2’s records and certainly, even if he was not directly responsible for the erroneous billing, a reasonable practitioner following this patient’s care ought to have noticed and corrected the deficiency.

SC2 testified that everything billed to her insurance was provided. She was quite adamant about knowing every detail of her appointments. The panel had difficulty accepting SC2’s evidence in this regard. It is hard to imagine that any patient would have the ability to recollect every single service provided at every appointment. SC2 [redacted] close friend of Dr. Solis and his wife. It was clear that she testified in a manner that she believed would be most helpful to the Member. This impacted her reliability and credibility. She refused to concede simple points and appeared to have an answer for every erroneous record or deficiency.

SC2 testified as to her involvement in gathering the patient records for the College investigator. She indicated that she believed that the complete files were provided and that nothing was missing. This evidence was contradicted by the testimony of the investigator, who confirmed that portions of the records were missing and further contradicted by SC2’s letter to the College wherein she acknowledged that portions of the records that were delivered were missing. The suggestion that the patient files were complete when they were provided to the College is not plausible.

Various Services Not Provided to SC1 and DM

SC1 is SC2’s husband and DM is her son. They both were Dr. Solis’ patients. Dr. Solis was closely involved in DM’s care in particular and knew or ought to have known as a result of his involvement that on numerous occasions DM’s insurer was billed for services not provided. At the very least, Dr. Solis ought to have noticed that there were gaps in the patient’s records and made the appropriate inquiries of his staff.

Similarly, Dr. Solis was directly involved in SC1’s care. They were family friends. Dr. Solis either knew or ought to have known that on numerous occasions there were services billed to SC1’s insurer that had not been provided. At the very least, a reasonable practitioner in Dr. Solis’s circumstances would have noticed the series of gaps in the patient’s records and made inquiries to find out what happened.

Claims for Gingivectomies

As set out above, the records indicate that with respect to at least some gingivectomies were billed to patients’ insurers, but it does not appear that the treatment was in fact provided. The records are consistent with the evidence of Dr. Trotti, the Member’s associate, who testified that she did not perform a gingivectomy on any patient at the Member’s Clinic. It is also consistent with the Member’s testimony that he did not perform gingivectomies on KL or GL, even though their insurer was billed for same.

The Panel heard evidence that whitening costs $400.00, which is about the same amount that can be charged for a gingivectomy or scaling appointment. Robin Viera and Rhonda Scott testified that as front office staff, they were instructed to bill for a gingivectomy when a whitening treatment was provided, because typically whitening was not an insurable benefit.

Claims for X-rays

The panel finds the Member responsible for the overbilling and billing errors associated with the x-rays. There are three main reasons that the Panel considered when making this decision:

There were simply too many x-rays missing from too many patient charts for this to be a case of a simple filing error. The assertion that if an x-ray was billed, it must have been taken and accidentally misfiled is not reasonable. The evidence from Dr. Solis’ associate confirmed that the x-rays were saved in digital form so that the treating dentist could access them in the operatory. Assuming that is correct, it would make it almost impossible to lose the x-rays if they were in fact taken. Similarly, Sandra Duckworth, another former front desk employee, testified that the paper copies of the x-rays were supposed to be placed in the patient’s file. While they might have occasionally been misfiled, the electronic copies should have been readily available.
It is highly unlikely that a dentist would not notice so many missing x-rays. It would make proper patient treatment impossible without taking new radiographs.
With respect to many of the missing x-rays described above, it is clear that multiple x-rays were often billed for one visit and that only some have gone missing. This certainly suggests that if there was a problem of misfiling, then all of the x-rays for a patient on a given day would be missing. Instead the only reasonable inference to draw is that where the x-rays are missing, they were in fact not taken at all.

C. Billed or Submitted False or misleading Claims

The records indicate that on several occasions, the Member’s patients were billed for one type of service, when another type of service was in fact performed. For the most part, these included claims submitted for complete examinations, when only a recall examination was provided.

Dr. Solis testified that the actual bills generated are the most accurate documents with respect to determining what treatment was provide. The panel does not accept this position. The clinical notes of the dentist and hygienist are the record of the services provided and treatment performed. When detailed clinical notes are absent, it is impossible for the treating dentist on the next visit to determine what needs to be done and it makes no sense that one would have to look at the billing records to determine a patient’s treatment history. The absence of clinical treatment records makes it impossible to cross reference the accuracy of billed procedures.

The panel rejects the suggestion that the complete examinations were conducted, where the records indicate they were not. The clinical notes and records make clear that in very many instances, the insurer was billed for a complete examination, where a recall examination is noted and where there would not even have been enough time to conduct a complete examination.

Dr. Solis is responsible for these billings irregularities as the treating dentist and clinic owner.

Billed for Local Anesthetic in Conjunction with Scaling

Dr. Solis submitted numerous claims for the administration of local anesthetic prior to scaling. According to the Ontario Dental Association Fee Guide and an ODA Practice Management article this is not a billable procedure. Dr. Solis admitted he was the attending dentist and charged patients for the administration of local anesthetic (ASF, pp 16-17, II-37).

Claims with Incorrect Dates of Service

On a number of occasions dates on insurance claim forms were incorrect. The Panel accepted that occasional errors may occur, but it became apparent that in this case there appeared to be a conscious effort to submit claims either early or late to maximize insurance coverage. Again, there were simply too many occasions where this occurred to accept that these were simply innocent clerical errors.

Further, the evidence of Robin Viera and Eileen Murphy was revealing. They both testified that on occasion they were instructed to manipulate the dates of service to maximize insurance coverage. This was consistent with the records which contained the date errors.

Claims Submitted for Periapical X-rays when Bite Wings Taken

Dr. Solis generally acknowledges that incorrect claims were made, and that on occasion bite wings were taken but periapicals were billed. The Panel was satisfied that the large number of instances where this happened precludes this from being explained as “innocent mistakes”. These “mistakes” appear to have occurred regardless of which hygienist or front office staff was working.

Dr. Solis either knew or ought to have known that these incorrect claims were being submitted under his name. At a minimum, Dr. Solis failed to exercise reasonable care to prevent these false claims from being submitted at all.

Allegation 4: Charging Excessive or Unreasonable Fees

The question the Panel dealt with in this allegation was whether the fee charged was excessive or unreasonable for the service provided. It did not consider whether the account was false or misleading.

SW1 and SW2 were both charged for complete examinations when only recall examinations were performed. Although Dr. Solis might have not have been the attending dentist to SW2, he is responsible for the billing accuracy because it was submitted in his name. A complete examination is much more expensive than a recall exam (Exhibit 4, Vol. 7, Tab 60A, p. 4310). The fees charged for these recall exams were therefore excessive and unreasonable.

Charges for the administration of local anesthetic when scaling was performed were also clearly excessive and unreasonable. The Ontario Dental Association has made it clear to the profession that a dentist cannot charge for this service.

Allegation 6: Failure to Collect Co-Pays

Dr. Solis has admitted that he failed to collect co-payments or deductibles from some patients. In no instance did Dr. Solis suggest that he obtained the insurer’s written consent not to collect the co-payment or deductible. As a professional and member of this College, Dr. Solis knew or ought to have known that he had to make efforts to collect co-payments from his patients or at a minimum advise insurers of the circumstances in advance. Having failed to do so, the Member committed professional misconduct.

Allegation 7: Failure to Provide Records to the College

The Panel finds the Member engaged in conduct or performed an act or acts that, having regard to all circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable, unprofessional or unethical.

This allegation is based on Dr. Solis’s failure to provide the College complete records for fourteen patients, those records were requested by the College. Dr. Solis has admitted he failed to provide complete patient records as requested.

Discipline Panels of this College and other Colleges under the RHPA have concluded that a failure to respond to the College’s requests, to provide records requested by the College, or to maintain records as requested by the College, constitutes disgraceful, dishonourable or unprofessional conduct; RCDSO v. McGregor January 29, 2018; RCDSO v. Fletcher (2017); RCDSO v. Prager (2015).

Summary

The panel understands that with regard to many of these allegations, Dr. Solis takes the position that he delegated much of the financial matters to his staff and so he is not responsible for any errors in reporting to insurers. The panel does not accept this argument.

Dr. Solis is the sole owner of the Clinic and as such is ultimately responsible for the conduct of his staff. Even if the Member was not aware of all of the billing irregularities, he ought to have taken greater care to ensure that his front staff were billing appropriately. This was a serious dereliction of duty by the Member. He should not have given up all control over the management of his office to staff.

In any event, given the serious deficiencies in the records reviewed, the panel finds it difficult to accept that Dr. Solis had no idea about the billing errors, missing x-rays and other deficiencies in the records. He either directed his staff or at least he knew that treatments not performed had been billed or billed incorrectly.

As the Clinic’s owner, Dr. Solis was the primary beneficiary of the billing discrepancies, which appear to have persisted for a number of years and during a number of staff changes at the Clinic.

Further, the panel could not accept that the number of missing records, including x-rays which had been billed was the result of innocent misfiling. It appears that the Member directed his Clinic staff to bill for x-rays not performed or to bill for x-rays in order to maximize his recovery from his patients’ insurers.

Dr. Solis orchestrated or at the very least allowed his Clinic to be run in a manner to mislead insurance companies for his ultimate benefit.

I, Richard Hunter, sign these Reasons for Decision as Chairperson of this Discipline Panel.

SCHEDULE “A”

H150017

IN THE MATTER OF a Hearing of a panel of the Discipline Committee of the Royal College of Dental Surgeons of Ontario held pursuant to the provisions of the Health Professions Procedural Code which is Schedule 2 to the Regulated Health Professions Act, 1991, Statutes of Ontario, 1991, Chapter 18 (the “Code”) respecting one DR. RICARDO SOLIS, of the City of Innisfil, in the Province of Ontario;

AND IN THE MATTER OF the Dentistry Act and Ontario Regulation 853, Regulations of Ontario, 1993, as amended (the “Dentistry Act Regulation”).

AND IN THE MATTER OF the Statutory Powers Procedure Act, Revised Statutes of Ontario, 1990, Chapter S.22, as amended; 1993, Chapter 27; 1994, Chapter 27.

TO: DR. RICARDO SOLIS

2089 THOMPSON ST

INNISFIL ON L9S 1T1

NOTICE OF HEARING

TAKE NOTICE THAT IT IS ALLEGED THAT:

You committed an act or acts of professional misconduct as provided by s.51(1)(c) of the Code, in that, you contravened a standard of practice or failed to maintain the standards of practice of the profession relative to one or more of the following patients during the year and/or one or more of the years specified opposite that patient’s name, contrary to paragraph 1 of Section 2 of the Dentistry Act Regulation.

Patients

Year(s)

BA.

2011, 2012

2013, 2014

TB1

2012, 2013

TB2

2011, 2012

2009, 2010, 2012, 2013, 2014

SC1

2013, 2014

SC2

2011, 2013, 2014

2011, 2012, 2013

2012, 2013

2011, 2012, 2013

2011

2012

KI.

2011, 2012, 2013

2007

2010, 2011, 2012, 2013, 2014

2011, 2012, 2013

2010, 2011, 2012, 2013

CS3

2011, 2012, 2013

BS.

2009, 2010, 2011, 2013

CS1

2009, 2013

2013

2010, 2011

2012, 2013

Particulars:

You exposed your patients to unnecessary ionizing radiation by taking x-rays too frequently, without justification (BA, LB, TB1, TB2, CB, SC1, SC2, BC, FC, BG, LG, LI, KI, ML, DM, SN, CS3, BS, CS1, JT, GT, RT, GY and NY).
You took an x-ray image of a patient’s healing fractured wrist, which was not within your scope of practice as a dentist (SI).

You committed an act or acts of professional misconduct as provided by s.51(1)(c) of the Code, in that, you recommended and/or provided an unnecessary dental service relative to one or more of the following patients during the year and/or one or more of the years specified opposite that patient’s name, contrary to paragraph 6 of Section 2 of the Dentistry Act Regulation.

Patients

Year(s)

2011, 2012

2013, 2014

TB1

2012, 2013

TB2

2011, 2012

2009, 2010, 2012, 2013, 2014

SC1

2013, 2014

SC2

2011, 2013, 2014

2011, 2012, 2013

2012, 2013

2011, 2012, 2013

2011

2012

2011, 2012, 2013

2007

2010, 2011, 2012, 2013, 2014

2011, 2012, 2013

2010, 2011, 2012, 2013

CS3

2011, 2012, 2013

2009, 2010, 2011, 2013

CS1

2009, 2013

AS.

2013

2010, 2011

2012, 2013

Particulars:

You exposed your patients to unnecessary ionizing radiation by taking x-rays too frequently, without justification (BA, LB, TB1, TB2, CB, SC1, SC2, BC, FC, BG, LG, LI, KI, ML, DM, SN, CS, BS, CS, JT, GT, RT, GY and NY).
You took an x-ray image of a patient’s healing fractured wrist, which was not within your scope of practice as a dentist (SI).

You committed an act or acts of professional misconduct as provided by s.51(1)(c) of the Code, in that you, signed or issued a certificate, report or similar document that you knew or ought to have known contained a false, misleading or improper statement relative to one or more of the following patients during the year and/or one or more of the years specified opposite that patient’s name, contrary to paragraph 28 of Section 2 of the Dentistry Act Regulation.

Patients

Year(s)

2010, 2011, 2012

TB1

2012

2009, 2011

TB3

2009, 2011

TB2

2010, 2011, 2012

2009, 2012, 2013, 2014

2009, 2011, 2012

SC1

2010, 2011, 2012

SC2

2011, 2012, 2013

2008

2008, 2011, 2013, 2014

2010, 2013

2011, 2012

2012

2008, 2010

2011, 2012

2009, 2011, 2012

2011, 2012

2007, 2008

2007, 2008, 2009, 2011, 2012, 2013

2007, 2008

2013

2008, 2012

2012

2010

2008

2012

2011, 2013

2011, 2012

2011

2010

2012

2012, 2013

2011, 2012

2011

2010

2008

CS2

2012

2011, 2012

CS1

2012

2010, 2011

CS3

2011, 2013

2012, 2013

2011, 2013

2012, 2013

2012

2008

2009, 2012

2007

2009, 2010, 2011

SW1

2008, 2010, 2011

SW2

2007, 2008, 2010, 2011, 2012, 2013

2010

2011

2012, 2013

Particulars:

You billed or submitted claims for dental services provided to one patient under the name of another patient as follows:

o You provided dental services for LG but you submitted a claim or claims for those services under the name of her husband, BG.

o You provided dental services for SC1 but you submitted a claim or claims for those services under the name of his wife, SC2.

o You provided dental services for SC1 but you submitted a claim or claims for those services under the name of SC2’s son, DM.

o You provided dental services to TI but you submitted claims for those services under the name of her son, JI.

o You provided dental services to JI but you submitted claims for those services under the name of KI.

You billed or submitted claims for dental services that were not provided in the following cases:

o You submitted claims for examinations that were not provided (TB1, TB2, CB, DC, BC, WC, BF, KG, BG, LG, KI, ML, VR, BS, CS1, SS, AS, JT, RT, JW, SW1, SW2 and GY).

o You submitted claims for a periodontal re-evaluation, recall examination, oral hygiene instruction, x-rays, scaling, polishing, fluoride treatments and de-sensitizations that were not provided (DM).

o You submitted claims for irrigations, periodontal re-evaluations, recall examinations, oral hygiene instruction, x-rays, scaling, polishing, fluoride treatments, desensitization and a periodontal appliance that were not provided (SC1).

o You submitted claims for periodontal re-evaluations, recall examinations, oral hygiene instruction, x-rays, scaling, polishing, fluoride treatment, desensitization, smoothing a traumatized tooth and a specific examination that were not provided (SC2).

o You submitted claims for gingivectomies that were not performed (AB, TB3, GL and KL).

o You submitted claims for x-rays that were not taken (BA, AB, TB3, TB2, DC, BC, BG, LG, TI, JJ, MK, GL, KL, SN, DP, CS3, BS, SS, PT, GT and RT).

o You submitted claims for an emergency examination and a denture that was not provided (SI).

o You submitted claims for x-rays, hygiene treatment, fluoride treatments and a cast/model that were not provided (KI).

o You submitted claims for scaling that was not provided (DC, LG and LI).

o You submitted claims for de-sensitization that was not provided (BC and RJ).

o You submitted claims for a pulpectomy, scaling and x-rays, that were not provided (FC).

o You submitted a claim for fluoride treatment that was not provided (LL).

o You submitted a claim for a fluoride treatment and de-sensitization that were not provided. (GY).

o You submitted a claim for oral hygiene instruction that was not provided (BC).

You billed or submitted false or misleading claims in the following cases:

o You submitted claims for complete examinations when you performed recall examinations (SW1 and SW2).

o You submitted claims for specific examinations when you performed complete examinations (LI and BW).

o You submitted claims for administering local anaesthetic when such claims were not justified as local anaesthetic is not a separate billable procedure when provided in conjunction with scaling or restorative treatment (TB1, LC, CF, NG, RJ, AK, PM, TM, RO, AP, DP, GP, SP, CR, VR, DT, SW1, JW and GZ).

o You submitted claims for a surgical flap with ostectomy (code 42411) and tooth coloured restorations (codes 23114) when you provided veneers for four teeth (SC1).

o You submitted a claim for a gingivectomy when you provided bleaching/whitening (SC1).

o You submitted a claim for a gingivectomy when you provided scaling (SC2).

o You submitted a claim for scaling when you provided bleaching/whitening (RJ).

o You submitted claims for scaling, desensitization, a complete examination,

x-rays, fluoride treatment and oral hygiene instruction when you provided bleaching/whitening (CS2).

o You submitted claims for an emergency examination, desensitization, a recall examination, x-rays, scaling, polishing and oral hygiene instruction when you provided bleaching/whitening (TS).

o You submitted claims with incorrect dates of service for various dental procedures you performed (BA, TB2, CB, BC, LG, KI, SI, TM and DP).

o You submitted claims for periapical x-rays when bite-wing x-rays were taken (CB, DC, SC2, FC, BF, BG, LI, KI, ML, DM, SN, DP, CS3, CS1, AS, JT and PT).

o You submitted claims for bite-wing x-rays when peri-apical x-rays were taken (WC and SI).

o You submitted claims for periapical x-rays when panoramic x-rays were taken (LG and CS1).

You committed an act or acts of professional misconduct as provided by s.51(1)(c) of the Code, in that, you charged a fee that was excessive or unreasonable in relation to the service performed relative to one or more of the following patients during the year and/or one or more of the years specified opposite that patient’s name, contrary to paragraph 31 of Section 2 of the Dentistry Act Regulation.

Patients

Year(s)

TB1

2011, 2012

SC1

2010

2008

2012

2008, 2010

2012

2008

2010

2012

2011

2010

2008

SW1

2008, 2010

SW2

2013

2010

2012

Particulars:

You submitted claims for complete examinations when you performed recall examinations (KI, SW1 and SW2).
You submitted claims for administering local anaesthetic with scaling and restorative treatment when such claims were not justified as local anaesthetic is not a separate billable procedure when provided in conjunction with those services (TB1, LC, CF, NG, RJ, AK, PM, TM, RO, AP, DP, GP, SP, CR, VR, DT, SW1, JW and GZ).
You submitted a claim for a complete examination when no charting was performed (SC1).
You submitted claims for a total of $1,900.00 for orthodontic treatment for KI but did not record any progress/treatment notes regarding orthodontic treatment, and the orthodontic treatment consisted only of a Hawley appliance.
You submitted a claim for an intra-operative endodontic periapical x-ray when such x-rays are included in the endodontic fee (TB1).

You committed an act or acts of professional misconduct as provided by s.51(1)(c) of the Code, in that, you submitted an account or charge for dental services that you knew or ought to have known was false or misleading relative to one or more of the following patients during the year and/or one or more of the years specified opposite that patient’s name, contrary to paragraph 33 of Section 2 of the Dentistry Act Regulation.

Patients

Year(s)

2010, 2011, 2012

TB1

2012

2009, 2011

TB3

2009, 2011

TB2

2010, 2011, 2012

2009, 2012, 2013, 2014

2009, 2011, 2012

SC1

2010, 2011, 2012

SC2

2011, 2012, 2013

2008

2008, 2011, 2013, 2014

2010, 2013

2011, 2012

2012

2008, 2010

2011, 2012

2009, 2011, 2012

2011, 2012

2007, 2008

2007, 2008, 2009, 2011, 2012, 2013

2007, 2008

2013

2008, 2012

2012

2010

2008

2012

2011, 2013

2011, 2012

2011

2010

2012

2012, 2013

2011, 2012

2011

2010

2008

CS2

2012

2011, 2012

CS1

2012

2010, 2011

CS3

2011, 2013

2012, 2013

2011, 2013

2012, 2013

2012

2008

2009, 2012

2007

2009, 2010, 2011

SW1

2008, 2010, 2011

SW2

2007, 2008, 2010, 2011, 2012, 2013

2010

2011

2012, 2013

Particulars:

You billed or submitted claims for dental services provided to one patient under the name of another patient as follows:

o You provided dental services for LG but you submitted a claim or claims for those services under the name of her husband, BG.

o You provided dental services for SC1 but you submitted a claim or claims for those services under the name of his wife, SC2.

o You provided dental services for SC1 but you submitted a claim or claims for those services under the name of SC2’s son, DM.

o You provided dental services to TI but you submitted claims for those services under the name of her son, JI.

o You provided dental services to JI but you submitted claims for those services under the name of KI.

You billed or submitted claims for dental services that were not provided in the following cases:

o You submitted claims for examinations that were not provided (TB1, TB2, CB, DC, BC, WC, BF, KG, BG, LG, KI, ML, VR, BS, CS1, SS, AS, JT, RT, JW, SW1, SW2 and GY).

o You submitted claims for a periodontal re-evaluation, a recall examination, oral hygiene instruction, x-rays, scaling, polishing, fluoride treatments and de-sensitizations that were not provided (DM).