Insurance Audits, Protecting your Practice

Insurance delisting of dental providers and clinics, how to avoid it and what can be done in the event of delisting. Continuing Education Learning Objectives By the end of this session, participants will be able to: • Describe the current insurance audit landscape in Canadian dentistry and identify emerging trends affecting dental practices, providers, and owners. • Recognize common factors that may increase audit risk, including documentation deficiencies, billing inconsistencies, administrative process gaps, and insurer concerns. • Explain the operational, financial, and reputational impacts of insurance audits on dental practices and their teams. • Discuss the consequences of insurer delisting and understand how delisting may affect patient flow, insurer relationships, practice valuation, recruitment, and practice transitions. • Identify key compliance strategies that support audit readiness, including governance, documentation standards, internal accountability measures, and continuous monitoring. • Evaluate the role of leadership in creating a culture of compliance that balances patient care, ethical billing, risk management, and business sustainability. • Describe the legal, regulatory, and professional considerations that arise during insurer reviews, investigations, repayment requests, and remediation efforts. • Understand the importance of proactive response planning when receiving audit requests, documentation reviews, or insurer inquiries. • Assess how insurer relationships, compliance history, and risk-management practices may influence the long-term value and marketability of a dental practice. • Apply insights from industry leaders, legal advisors, practice operators, and professional association representatives to strengthen compliance and reduce organizational risk.