Dentists shall be obliged to seek consultation, if possible, whenever the welfare of
patients will be safeguarded or advanced by utilizing those who have special skills,
knowledge, and experience. When patients visit or are referred to specialists or
1. The specialists or consulting dentists upon completion of their care shall return the
patient, unless the patient expressly reveals a different preference, to the referring
dentist, or, if none, to the dentist of record for future care.
2. The specialists shall be obliged when there is no referring dentist and upon a
completion of their treatment to inform patients when there is a need for further
dental care.
4.E. REBATES AND SPLIT FEES.
Dentists shall not accept or tender “rebates” or “split fees.”
ADVISORY OPINION
4.E.1. SPLIT FEES IN ADVERTISING AND MARKETING SERVICES.
The prohibition against a dentist’s accepting or tendering rebates or split fees
applies to business dealings between dentists and any third party, not just other
dentists. Thus, a dentist who pays for advertising or marketing services by
sharing a specified portion of the professional fees collected from prospective or
actual patients with the vendor providing the advertising or marketing services
is engaged in fee splitting. The prohibition against fee splitting is also applicable
to the marketing of dental treatments or procedures via “social coupons” if
the business arrangement between the dentist and the concern providing the
marketing services for that treatment or those procedures allows the issuing
company to collect the fee from the prospective patient, retain a defined
percentage or portion of the revenue collected as payment for the coupon
marketing service provided to the dentist and remit to the dentist the remainder
of the amount collected.
Dentists should also be aware that the laws or regulations in their jurisdictions
may contain provisions that impact the division of revenue collected from
prospective patients between a dentist and a third party to pay for advertising
or marketing services.
5.F.4. REFERRAL SERVICES.
There are two basic types of referral services for dental care: not-for-profit and
the commercial. The not-for-profit is commonly organized by dental societies or
community services. It is open to all qualified practitioners in the area served. A fee
is sometimes charged the practitioner to be listed with the service. A fee for such
referral services is for the purpose of covering the expenses of the service and
has no relation to the number of patients referred. In contrast, some commercial
referral services restrict access to the referral service to a limited number of
dentists in a particular geographic area. Prospective patients calling the service may
be referred to a single subscribing dentist in the geographic area and the respective
dentist billed for each patient referred. Commercial referral services often advertise
to the public stressing that there is no charge for use of the service and the patient
may not be informed of the referral fee paid by the dentist. There is a connotation
to such advertisements that the referral that is being made is in the nature of a
public service. A dentist is allowed to pay for any advertising permitted by the
Code, but is generally not permitted to make payments to another person or entity
for the referral of a patient for professional services. While the particular facts and
circumstances relating to an individual commercial referral service will vary, the
council believes that the aspects outlined above for commercial referral services
violate the Code in that it constitutes advertising which is false or misleading in a
material respect and violates the prohibitions in the Code against fee splitting.
