In Florida, the corporate practice of dentistry is subject to stringent regulations designed to ensure that only licensed dentists have control over dental practices. This regulatory framework is crucial for maintaining the integrity of dental care and protecting patients from potential conflicts of interest that may arise when non-dentists are involved in the management of dental practices. This blog post explores the key restrictions under Florida law and the role of Dental Practice Management Companies (DPMCs) in navigating these regulations.

Ownership and Control Restrictions

Pursuant to Fla. Stat. Section 466.026(1) and F.A.C. 64B5-17.013(1), only dentists licensed in the State of Florida or professional corporations composed entirely of licensed dentists can own and operate dental practices or engage in the practice of dentistry in the State of Florida. Non-dentists may provide and lease dental equipment and materials to dentists, however, non-dentists are prohibited from controlling the use of dental equipment or materials during the actual provision of dental services, whether such services are provided by a dentist, dental hygienist, or dental assistant. Furthermore, any lease agreement, rental agreement, or other arrangement between a non-dentist and a dentist whereby the non-dentist provides dental equipment or dental materials must contain a provision whereby the dentist expressly maintains complete care, custody, and control of the equipment or practice as provided by Fla. Stat. Section 466.0285(1). This restriction ensures that clinical decisions remain solely in the hands of qualified dental professionals, thereby safeguarding patient care.

Prohibited Practices for Non-Dentists

The clinical judgment of a licensed dentist must be exercised solely for the benefit of his/her patients, and must be free from any compromising control, influences, obligations, or loyalties. Pursuant to Fla. Stat. Section 466.0285, non-dentists are expressly forbidden from interfering with a dentist’s clinical judgment in many ways, including, without limitation, the following:

• Employ a dentist or dental hygienist in the operation of a dental office.
• Directing or controlling the selection of treatment courses, the procedures or materials used, and the manner in which treatments are carried out. 
• Exercising control over patient records, pricing policies, or decisions related to office personnel and hours of practice. 
• Any contract or arrangement that violates these restrictions is considered void and contrary to public policy.

Dental Practice Management Companies and Practice Management Agreements

Dental Practice Management Companies (DPMCs), also commonly referred to as Dental Practice Management Organizations (DPMOs), Dental Service Organizations or Dental Support Organizations (DSOs), can play a significant role in supporting dental practices by providing “Practice Management Services” (as defined in F.A.C. 64B5-17.013(4)) to dentists and dental practices under the terms of a Practice Management Agreement without violating Florida’s Corporate Practice of Dentistry restrictions. Practice Management Services that may be provided by a DPMC to a dental practice, include:

• Providing consultation services with respect to (i) the suitability of dental office space, furnishings and equipment, (ii) the staff necessary to operate a dental practice, (iii) inventory and supplies required to operate a dental practice, (iv) regulatory compliance, and (v) methods to increase productivity of a dental practice.
• Providing administrative support services, marketing services, information systems, and financial services such as accounting and bookkeeping, monitoring and payment of accounts receivable, payment of leases and subleases, payroll or benefits administration, billing and collection for patient services, payment of federal or state income tax, personal property or intangible taxes, administration of interest expense or indebtedness incurred to finance the operation of the dental practice, or malpractice insurance expenses.

However, Practice Management Agreements between dentists and DPMCs must adhere to specific regulatory restrictions. Pursuant to F.A.C. 64B5-17.013(5), a Practice Management Agreement shall not:

•  Preclude or otherwise restrict, by penalty or operation, the dentist of record’s ability to exercise independent professional judgment over all qualitative and quantitative aspects of the delivery of dental care.
• Limit or define the scope of services offered by the dentist of record or the dentist of record’s practice.
• Limit the methods of payment accepted by the dentist of record or the dentist of record’s practice.
• Require the use of patient scheduling systems, marketing plans, promotion or advertising for the dentist of record or the dentist of record’s practice which, in the judgment of the dentist of record or the dentist of record’s practice will have the effect of discouraging new patients from coming into the practice or discouraging patients of record from seeing the dentist or postponing future appointments or which gives scheduling preference to one individual, class or group of existing or new patients over another individual, class or group of existing or new patients.
• Penalize the dentist of record or the dentist of record’s practice for reporting perceived violations of this section to, or seeking clarification from, appropriate state or federal agencies, departments or boards.

Importantly the management fees charged by DPMCs must reflect the fair market value of the practice management services provided and cannot be based on patient referrals. This ensures that the financial arrangements do not compromise the dentist’s independent professional judgment or the quality of care provided to patients. Accordingly, management fees should not be determined as a percentage or portion of the dental practice’s gross or net profits (as may be allowed in other jurisdictions) as such may not reflect the fair market value of services actually provided. DPMCs should keep records of costs and expenses incurred in their provision of Practice Management Services, and should consider obtaining a third-party evaluation of the fair market value of the services they provide to their clients.

Finally, a Practice Management Agreement cannot prohibit a licensed dentists from competing in the provision of dental services with a DPMC except as permitted by chapter 542, Fla. Stat.

Navigating the restrictions on the Corporate Practice of Dentistry in Florida requires a thorough understanding of the legal restrictions and careful structuring of the relationships between dentists and non-dentist entities. By adhering to these regulations, dental practices can ensure compliance while benefiting from the administrative and operational support offered by Dental Practice Management Companies.

For assistance with the formation of a Dental Practice Management Company, drafting and negotiation of Practice Management Agreements, or further information regarding Florida’s restrictions on the Corporate Practice of Dentistry, please contact the author at mclare@foxrothschild.com or 941-308-2676. More information can be found at www.foxrothschild.com/healthlaw. Mark Clare is an Associate and member of the Health Care Transactions Practice Group at Fox Rothschild LLP. Mark is based in Sarasota, Florida and specializes in assisting clients with corporate, health law and M&A matters.