Australian dentistry: Michael Zaninovich blasts holes in regulators’ attempts to stop ‘inappropriate conduct’

Moves to tackle “inappropriate conduct” by dentists amid an explosion in Australians emptying their superannuation accounts to pay for expensive procedures will likely backfire, a top surgeon has warned. WA prosthodontist Dr Michael Zaninovich said new rules by the medical regulator to prevent abuse of the Compassionate Release of Super (CRS) scheme risked the opposite effect. He predicted more dental businesses would outsource their advertising to viral marketing firms — not subject to the rules — because doing it in-house was now too prohibitive and practices risked big penalties if they were found to be in breach. The proliferation of such marketing firms, bombarding Facebook and Instagram with ads for dental implants, has coincided with a massive surge in Australians withdrawing large sums from their superannuation funds under CRS provisions to pay for the procedures. The amount paid out has increased by 1131 per cent in seven years, from $66.4 million in 2018-19 to $817.6m last year. Just the increase in the past year was 55.32 per cent. The CRS scheme is for critical medical and dental procedures and should only be used as a last resort, not for cosmetic reasons. The raid on funds, meant to pay for retirement, has alarmed the ATO, which has joined forces with the Australian Health Practitioner Regulation Agency (AHPRA) to combat abuse of CRS and business models that use super as a pot of gold to pay for overly expensive or unnecessary procedures. But AHPRA can only rein in the behaviour of dentists, some of whom it claims are putting profits before patient care, and not the third-party marketing firms, who get paid handsome commissions for providing leads to clinics. Dr Zaninovich, of Perth’s Aria Dental, said he didn’t want to sign up with the marketing firms, but commercially, he had little choice because he was losing business to dentists who were less qualified. “Cut a long story short, I can no longer put out a video of you coming into my clinic with bad looking teeth and then showing how happy you are after you finish (the procedure),” he said. “But the marketing companies are not bound by these rules, so it’s tipped the balance away from dentists having power over their businesses. It’s pushed us towards (using these marketing companies).” Dr Zaninovich was a hero to many of the former patients of rogue Perth dentist David Hurst, who stepped in to provide urgent care to them following botched and incomplete treatment in the wake of Dr Hurst’s sudden death in December last year. As revealed by The Sunday Times, it was later discovered that Dr Hurst had spent $2.36m of pre-payments from more than 130 of his patients — some of whom had been waiting for their treatment to start and had coughed up about $70,000 each for full top-and-bottom implants. Dr Hurst had insisted they pay in-full upfront. His staff accessed their MyGov accounts to apply for early release of super on their behalf. The scandal, which left patients with no teeth and in some cases zero superannuation afterwards, helped persuade authorities to strengthen the code of conduct for dentists. This newspaper also revealed Dr Hurst had previous convictions for fraud in the UK, connected to his dental work in Wales. The revelation prompted questions about how he was allowed to practice in Australia. Today, The Sunday Times can reveal that in the months before his death he was swamped with patients wanting implants, courtesy of a flood of leads provided to him by The Viral Digital Agency Pty Ltd trading as Dental Boss. In a testimonial he provided to Dental Boss, Dr Hurst said he had made $500,000 in “new patient production” within 90 days of signing up. “We were inundated with patients and inundated to the point I couldn’t even believe it . . . we weren’t ready for it,” he said. He wasn’t ready for them, but he took their life-savings anyway. In the wake of his death and the collapse of his company, Hurst Group Pty Ltd, it emerged that he’d withdrawn millions from the business, helping him buy a mansion in Claremont, luxury cars and lead a flashy lifestyle with lots of overseas holidays and first class international flights. His deceased estate was declared bankrupt in August and it remains to be seen if the trustee overseeing the bankruptcy will go after his former home, now in his widow Clara Hurst’s name, to recover money for creditors, which includes the insolvent Hurst Group Pty Ltd of which ripped-off dental patients are creditors. The biggest is Dr Zaninovich who wasn’t paid for the work he did for the company, worth $465,000, following Dr Hurst’s death. There is another intriguing and previously unreported quirk about the saga. Several of the impacted patients initially thought they were signing up with a business called Nova Dental Implant Centre. They had responded to its Facebook ads and received follow-up phone calls from its consultants. During these calls, the patients provided information about their health and their teeth, as well as details on how they wanted to pay for implants. Whilst on the phone, they also paid $75 to secure a consultation with a dental surgeon. It was at that point they were referred to Dr Hurst’s practice. They thought nothing of it at the time. One of Dr Hurst’s key admin staff even signed off with “Nova” in her correspondence with patients. Nova, which operates a network of clinics around Australia, this week insisted it did not refer any patients to Dr Hurst or his former practice. “Nova Dental Implant Centre has no operational connection with Perth Dental Rooms or Dr Hurst,” the company said in a statement. “The two practices were entirely independent businesses that operated separately within the same market. Furthermore, most entities now trading under the Nova Dental Implant Centre brand did not exist at the time of the events in question. “All Nova clinics are managed and operated by registered dental practitioners who provide treatment directly to patients under the Nova brand.” Company searches reveal that Nova and The Viral Digital Agency Pty Ltd are related entities with the same director and shareholder. Questions to the latter company, trading as Dental Boss, went unanswered. In one ad to dentists, Dental Boss pitched: “Double Your Practice & Fill Your Books With Big Case Prepaid Patients WITHOUT Having To Call ANY Leads.” On its LinkedIn page, the Queensland-based business, states: “We give dental practice owners a reliable and predictable way to acquire new high-value patients for their clinics without them having to do any of the work to get these patients in. We work the leads, we pre-qualify the leads, and we also book the new pre-paid patient appointments.” On its Instagram page, dentists enthuse about the boost Dental Boss has given to their bottom lines and of the value of getting pre-qualified leads. There is no suggestion of any wrongdoing by Dental Boss or Nova in regard to the losses or bad predicament of Dr Hurst’s former patients. AHPRA’s CEO Justin Untersteiner said he was “stunned” that practitioners were abusing CRS. “We are seeing practitioners making inaccurate statements in medical reports,” he said. AHPRA this week said the onus was on dentists to ensure only patients who met the strict eligibility requirements for CRS were able to access it. “Regardless of how a dentist finds their patients, either through their own advertising or third party advertisers, any application for access to the CRS scheme . . . must be supported by accurate reports and assessments from practitioners,” a spokesperson said. “Practitioners have a clear duty to prioritise patient safety and act in their patient’s best interests. Individual dentists have obligations around the accuracy of reporting as well as the adequacy of assessments. Dentists must ensure patients give full informed financial consent regardless of the referral pathway.” The regulator said it was also looking closely at the advertising of marketing companies. “While AHPRA does not regulate the professional conduct of these third party entities, we are concerned if the advertising is misleading or encouraging indiscriminate use of a regulated health service,” the spokesperson added. “Any advertising of health services is subject to regulation under the current guidelines, even if a dental practitioner is not controlling the advertising. “Where a practitioner knows that a business model exploits patients or operates contrary to their interests, they should disengage from that service and consider reporting their concerns to the appropriate regulator.” The ATO said it was also investigating. “Charging or receiving a fee or other reward to assist individuals to prepare or submit an application to access super on compassionate grounds is a tax agent service and requires registration with the Tax Practitioners Board,” a spokesperson said. ”Providing this service for a fee or other can result in significant financial penalties being imposed by the Federal Court. “In addition, influencing or advising patients to access their super early without an Australian financial services licence may involve providing financial product advice. Providing such advice without a licence can result in severe penalties and other regulatory action from ASIC.” Under the new rules, dentists cannot encourage patients to pay for treatments by accessing their super under CRS, or take on personal loans. Instead, they should encourage patients to seek independent financial advice. Advertising must not use patient stories or anecdotes that may create an unreasonable expectation of beneficial treatment. AHPRA said the outcomes experienced by one person do not necessarily reflect the outcomes that other people may experience. There is also concern about confidential patient information being shopped around, especially when they don’t realise they’re talking to a marketing company. Ex-patients and other creditors of Mr Hurst’s former company voted to replace the liquidator in September. New liquidator Jennifer Low said her initial investigations were continuing. However, as she is without any funds, she made an application to ASIC’s Assetless Administration Fund last month for funding to carry out a full and proper investigation. She said she was currently awaiting a response. Bankruptcy trustee Mark Roufeil said his investigations into the deceased estate of Dr Hurst were at an early stage and it wasn’t yet appropriate to comment.