Miller v. Commonwealth

396 A.2d 83, 39 Pa. Commw. 613, 1979 Pa. Commw. LEXIS 1343
CourtCommonwealth Court of Pennsylvania
DecidedJanuary 11, 1979
DocketAppeal, No. 967 C.D. 1977
StatusPublished
Cited by3 cases

This text of 396 A.2d 83 (Miller v. Commonwealth) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Miller v. Commonwealth, 396 A.2d 83, 39 Pa. Commw. 613, 1979 Pa. Commw. LEXIS 1343 (Pa. Ct. App. 1979).

Opinions

Opinion by

Judge MacPhail,

Appellants, 'all of whom are ¡oral surgeons licensed by the State Dental Council ¡and Examining Board (Council) to practice, dentistry in Pennsylvania, appeal from an adjudication and order of the Council which suspended their licenses to practice'1 because of alleged violations of Section 3(i) of The Dental Law (Law), Act of May 1, 1933, P.L. 216, as amended, 63 P.S. §122.2 The Council took its action after four days of .extensive hearings. Its .adjudication .includes 114 separate findings of fact. It is quite obvious to us that .this case received the very careful consideration it deserved .and that the Council acted only after deliberating at length. ,-

[616]*616During the period from 1969 through 1971, all of the Appellants practiced oral surgery in the Miller Clinic (Clinic) which was a sole proprietorship operated and ¡supervised by the Appellant, Miller. An investigation iand review conducted by representatives of Pennsylvania Blue Shield of those persons or institutions receiving more than $10,000.00 in payment for oral surgery services for any specific year revealed numerous discrepancies at the Miller Clinic. These discrepancies were reported to the Council whereupon ■citations were issued to each of the Appellants charging them with violating Section 3 (i) of the Law. Specifically, Miller, as the chief administrative and supervising dentist, ¡and each of the other Appellants as the actual perpetrators were, cited for filing false claim reports with Pennsylvania Blue Shield. The Council found that such false claim reports had been filed and concluded that that practice violated that portion of Section 3(i) of the Law which prohibits fraudulent or unlawful practices or fraudulent misleading or deceptive representations and unprofessional conduct detrimental to the. public health, safety, morals or welfare.

From the record it appears that the Clinic operated mostly on referrals from other dentists. When a patient appeared at the Clinic for the first time, a patient chart form was completed and a panorex x-ray was taken. The patient was then seen by one of the surgeons at the Clinic and the type of work to be done was determined. For each patient the record of treatment was recorded on the patient’s chart by the surgeon performing the treatment. The surgeon who performed the surgery was responsible for listing the exact operative procedure on the patient’s chart. Surgery was performed either at the Clinic or at a nearby hospital. Patient charts and cards went with the patient at all times. At the end of the day the pa[617]*617tient’s charts were taken to the business -office located in the basement -of the Clinic and there- -all information was transferred by a secretary from the patient’s dental charts to- -a charge card -or insurance form. Insurance fo-rms -submitted to Pennsylvania Blue Shield were -stamped with the treating surgeon’s signature. Each -of the surgeons had executed an authorization agreement accepting full responsibility for all statements, representations -and certifications appearing on claims submitted to Pennsylvania Blue Shi-e-ld to which his signature stamp had been affixed. Occasionally, the treating surgeon would send a personal note of appreciation to ¡the- forwarding dentist. Such n-o-tes bore- the handwritten signature of the treating surgeon. The- Appellant, Miller, “ran” the Clinic -and was its -s-ole administrative- supervisor. The records of the Miller Clinic for the years which were -the subject o-f the investigation were- destroyed by a flood.

Blue Shield M-edical/Surgioal Agreements in effect for the period in question -excluded coverage for oral surgical services related to th-e care- or -extraction of teeth other than fully or partially impacted teeth. Appellants were cited f-or -submitting claims to Blue Shield for the removal -of impacted teeth when, in fact, the Council found that the x-rays and -other documents available to them indicated that the teeth extracted were not impacted. Appellant Snell was cited for four such cases, Hughes f-o-r two, -and Lov-ette for six. At the time -of the hearing an .exhibit was submitted to the Council indicating that more than a hundred such discrepancies had been documented and that the specific oas-es submitted to the Council were -only representative -of -that larger number. Although the exhibit was admitted -over -objection, -the Council made no reference to it in its findings of fact or conclusions.

[618]*618Appeals oe Dks. Snell, Hughes and Lovette

Appellants contend that the Council erred when it received into evidence, over objection, the report from the Blue Shield investigators disclosing 130 alleged discrepancies at the Clinic. Appellants do .admit, as they must, that there is no reference to that report in the findings, conclusions or discussion by the Council. Appellants argued to- the Council and to this Court that 'the. 13 claims examined by the Council were almost insignificant compared to the vast number of cases processed by the Clinic. The exhibit was offered into, evidence in anticipation that just such an argument would be made and to indicate to the Council that the 13 cases that they were hearing were merely representative of much wrongdoing at the Clinic.

. It is well established that administrative agencies and boards are not held to strict compliance with the rules of evidence'. Walker v. Unemployment Compensation Board of Review, 27 Pa. Commonwealth Ct. 522, 367 A.2d 366 (1976). However, the report was clearly hearsay and should have been excluded in view of the strenuous objections made to its admission. Nevertheless, we hold .that the .error was harmless in light of the fact that that report was not used to support any findings by the Council. Walker v. Unemployment Compensation Board of Review, supra. The record here is clear that the Council considered only the Í3 cases actually submitted to and beard by it.

Appellants contend that there is a lack of substantial evidence to prove that the claims were incorrect in fact. While there may be room for reasonable minds to differ as to what is or is not an impacted tooth, the Council is composed of professional people judging their peers and we are well satisfied that their [619]*619findings were based upon credible testimony by competent witnesses and that that testimony, together with the numerous exhibits received, was sufficient to convince .a reasonable mind to a reasonable degree of certainty that claims were submitted by the Clinic to Blue Shield for the extraction of teeth which were not impacted. State Board of Osteopathic Examiners v. Berberian, 200 Pa. Superior Ct. 533, 190 A.2d 330 (1963).

Appellants then argue that if there were false claims submitted, they were the responsibility of clerical help. There is nothing in the record of 'this case to support such a conclusion. To the contrary, the evidence is that the clerical help simply transferred to claim forms the information given to them by the surgeons. Moreover, the argument seems almost ludicrous in view of the fact 'that the Appellants assumed full responsibility for 'all information submitted over their signature stamps to Blue Shield.

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Bluebook (online)
396 A.2d 83, 39 Pa. Commw. 613, 1979 Pa. Commw. LEXIS 1343, Counsel Stack Legal Research, https://law.counselstack.com/opinion/miller-v-commonwealth-pacommwct-1979.