Episode #377: Legal essentials that help dentists grow with confidence with attorney Evan Sampson

Intro: This is the Less Insurance Dependence podcast show with my good friend Gary Takacs and myself, Naren Arulrajah.

Intro: We appreciate your listenership, your time, and most of all, we appreciate your intention to reduce insurance dependence in your practice. Our goal is to provide information that will help you successfully reduce insurance dependence and convert your practice into a thriving and profitable dental practice that provides you with personal, professional, and financial satisfaction.

Lester De Alwis: Hello everyone. Welcome to the Less Insurance Dependence podcast. I’m your co-host, Lester De Alwis. This podcast helps dental professionals gain control of their practice, reduce insurance pressure, and build a strong and stable future.

Before we begin, here’s a quick message from our sponsor. Ekwa Marketing is offering a complimentary marketing strategy meeting. Basically, their expert team will show you how to attract high-quality new patients and grow with strong online visibility. So if you ever want to check on your online visibility, visit lessinsurancedependence.com/marketing-strategy-meeting  to schedule your session.

If you’re looking for mentorship and you want to move forward with a fee-for-service model, you can also schedule a complimentary coaching strategy meeting with Gary Takacs at thrivingdentist.com/csm. 

Now, on to today’s conversation. Today, we have a very special guest. I’m excited to welcome Attorney Evan Sampson. Evan has spent more than a decade helping dentists and dental organizations with compliance and employment law, regulatory issues, contracts, and the legal side of practice growth. He brings a practical and clear approach to help dentists protect their practice and grow with confidence.

Our episode today is titled Legal Essentials That Help Dentists Grow With Confidence with Attorney Evan Sampson.

So, Evan, help us understand compliance risks, part-time employment law changes, and how strong legal systems support a practice that wants less stress and more independence. Everyone, we’re excited to have you here. Thank you for joining us.

Evan Sampson: Thank you so much for having me.

Lester De Alwis: So before we begin, I know since you’re an attorney, there’s a disclaimer to be made, so why don’t you go ahead and let the audience know about that.

Evan Sampson: Oh, thank you so much. Um, so I just need to say that this conversation does not constitute legal advice and does not create an attorney-client relationship. If any of your listeners have any questions, they are free to reach out to me once they listen to the podcast.

Lester De Alwis: Wonderful. So, to start, what are the most common compliance issues you see that tend to slow down the practice growth?

Evan Sampson: Um, so one of the biggest issues I tend to see that impedes practice growth is not having the right systems, policies, and procedures in place as you grow. I always recommend to my clients to have systems in place as early as possible, or at least plan for the implementation of the right policies and procedures, because changing the culture of a practice later, once it’s established, can really be a big challenge.

So one big area that I always touch on is employment law practices. I always recommend to my clients, no matter how small they are, the adoption of things like an employee handbook, the use of offer letters with their employees with job descriptions, 30-60-90 day plans for new hires, and performance improvement plans for employees who aren’t living up to your expectations. These kinds of small initiatives can help create a culture of transparency within the workforce, and it clearly communicates goals and expectations to every employee.

Lester De Alwis: Amazing. I think that gives a great start and a great overview of the common roadblocks. Now, let’s shift to growth. So many dentists want to scale through adding locations, associates, or strategic partnerships. What legal challenges tend to appear early in that journey?

Evan Sampson: So, growth tends to bring complexity, and many kinds of these arrangements—whether they be lease negotiations, real estate purchases, associate agreements, or partnerships with investors or maybe specialists—those kinds of agreements can be heavily negotiated. So the failure to ensure as much uniformity as possible with these different categories can create accounting challenges that can be avoided and lead to administrative costs.

For example, if you have seven or eight employees and their compensation structures are different—maybe some of them are paid twice a month, some of them are paid once a month, maybe some of them are paid on the 15th of the month, some of them are paid on the final day of the month—someone’s got to manage all that, and someone’s got to keep track of all that. So if you’re not planning accordingly on things like that, that creates a lot of headaches for the practice, right?

And as the attorney negotiates those deals, if you have to come to me every time to tweak language, to change language—especially around compensation, but around other things—that’s time spent that you could be focusing on other things like marketing. Or that’s legal spend that could be avoided if you stick to your guns, have a plan, and make sure you’re approaching these things with as much uniformity as possible.

Lester De Alwis: Amazing. And like you said, I mean, scaling brings many moving parts. Now, are there any advantages or misconceptions when it comes to compliance in a financially independent practice or a practice less reliant on insurance-driven revenue?

Evan Sampson: So financial independence definitely reduces the risk of fraud, waste, and abuse, but it doesn’t eliminate it. And what do I mean by fraud, waste, and abuse? I mean the kind of compliance headaches that come with either commercial payer denials and recoupment requests, or even things like Medicaid audits and whatnot.

So, if you’re not really relying on insurance, you’re going to see a lot less of those kinds of issues than an insurance-dependent practice would. But believe it or not, financially independent practices can still run into issues with insurance companies. For example, they may find themselves having to assist patients to appeal claims with their insurance companies. Even practices that don’t want to deal with insurance end up dealing with those kinds of issues because their patients need it.

And I’ve seen it before, but even these kinds of practices may need to contest payment inappropriately or erroneously sent directly to the dental office as reimbursement from an insurance carrier who didn’t know what they were doing. So there’s definitely less risk and there’s definitely less administrative headache, but sometimes even a practice that’s financially independent may find themselves in these situations.

The other important thing to note is financial independence doesn’t really reduce risk in other areas that I commonly encounter. So employment law issues are still going to matter, and employment law sometimes butts up against tax law and other considerations. Licensing obligations are still impacted. So there are definitely some advantages to being financially independent or reducing the number of insurance companies you participate with, but it doesn’t eliminate all the risks and all the daily headaches that come with managing a growing dental practice.

Lester De Alwis: Exactly that. I think that insight is very helpful. And another area that causes stress for dentists is HIPAA. So HIPAA violations are becoming more common in digital workflows. What overlooked risks should dentists be aware of and how can they protect themselves?

Evan Sampson: So one issue that’s emerging is the issue of artificial intelligence, and I would say especially for privacy concerns like HIPAA, avoid utilizing consumer-facing generative AI products like ChatGPT, because any PHI entered into ChatGPT or other similar products will be used to teach their large language model, right? You don’t want your patient’s private, confidential information to educate the system so that it can then communicate with dozens of other people.

When it comes to HIPAA, I always say to my clients, use HIPAA-compliant systems. And what does that mean? Any vendor who you deal with who needs access to PHI, especially in the IT sphere, they’re usually going to be willing to enter into what are called business associate agreements. This is an obligation that’s imposed under HIPAA.

So if someone you’re dealing with is going to get access to PHI, or maybe you’re not even sure, if you ask, "Are you going to sign a BAA?" and they say, "What’s a BAA?" you know that’s probably a red flag. Certain vendors, especially large companies, may say, "We’re not HIPAA compliant." I mean, that’s a sign that you should either think about moving forward with that kind of vendor and look for one who is HIPAA compliant, or maybe it’s something you can think about—how to make sure that whatever patient information that vendor may have access to will be anonymized or something similar to protect the patient’s privacy.

Lester De Alwis: Exactly. I think that makes things clear about HIPAA compliance. And now, when it comes to—we talk about team—employment law is evolving quickly, especially with remote roles and multi-location practices. What should practice owners understand to stay compliant?

Evan Sampson: Um, employment laws can vary dramatically between states, even states that are close together, especially in the areas of PTO accrual, sick leave, and the use of restrictive covenants. Remote employees are generally entitled to the protections of the laws in the state where they’re performing the work in. So remote employees working in employee-friendly states may be entitled to protections that your other employees may not have.

So I always caution my clients against spreading their employee base too, too broadly. I’ve worked with a number of growing practices that have remote employees in seven or eight different jurisdictions. Keeping track of PTO accrual, whether PTO can roll over at the end of the year, whether there’s use-it-or-lose-it laws, what sick leave these employees are entitled to—those can cause real administrative headaches.

Evan Sampson: So, before you agree to onboard any remote employee in a far-off, long-distance jurisdiction, just make sure you’re aware of these issues, because they can be a headache later.

Another issue I tend to caution my clients against is onboarding associate dentists as 1099 independent contractors. This is a very common issue that I often see a lot of growing practices do. This practice can potentially be flagged in a tax audit or in a workers’ compensation audit. So I generally recommend onboarding any associate dentists as employees of the practice—W-2 employees—rather than 1099 independent contractors.

Lester De Alwis: Amazing, great guidance. And to close out, for dentists who want to build a scalable, legally strong practice, what steps should they take today to protect themselves and prepare for growth?

Evan Sampson: I always recommend getting the appropriate written policies and procedures in place early, and that includes having an appropriate training regimen for your employees. So when anything ever goes wrong in a dental practice, usually the first two questions that get asked are: were there written policies in place? And was the employee who committed the violation trained on this? Those are always the two questions I get asked, whether it be by an insurance company, a regulator, whoever.

So if the answers to these two questions are no—there were no written policies, and the employee wasn’t trained—it usually doesn’t look good. If you have these two things in place, and you know that they’re the correct things to have in place, then one, that’s going to mitigate any problems you run into, because you’re going to be prepared for them.

And two, God forbid something were to happen—no one’s perfect, things go wrong all the time—you at least know you have the right procedures in place so that if anyone who you don’t want asking asks these questions, you can tell them, “Yes, we’re doing our best to make sure this stuff, one, didn’t happen in the first place, and we’re also doing our best to make sure it doesn’t happen in the future.”

If you don’t know what the appropriate things are to have in place, I always say talk to an expert. There are trade associations out there, your state dental societies, there are people like your podcast, right?

Lester De Alwis: Yes, exactly.

Evan Sampson: So I would always say, if you’re not sure, reach out to an expert and figure out what you need to have in place to best protect your practice.

Lester De Alwis: Exactly. So our community—our listeners—our podcast is all about taking action. So if our listeners want to get in touch with you or get more information about today’s episode, what you just shared, how can they reach out to you?

Evan Sampson: So my law firm is called Post & Schell—P-O-S-T and S-C-H-E-L-L. If you Google my name and Post & Schell, you’re going to see my bio. But if you want to send me an email, my email address is esampson@postschell.com. Feel free to contact me. I love connecting with dentists, and I absolutely love helping them with their problems. So please feel free to reach out to me.

Lester De Alwis: Exactly. So to anyone listening in, if you want to basically get expert advice on the legality of the content that was shared on this episode, please reach out to Evan on the email address that we shared.

So Evan, thank you for joining us today and sharing such valuable insight on compliance, growth, and legal planning for dental practices.

Evan Sampson: Thank you so much for having me.

Lester De Alwis: So the key takeaway is that when dentists understand compliance, protect their systems, and prepare for growth, they build a stronger and more independent practice. This foundation helps reduce stress, reduce risk, and support a future with less insurance pressure.

This podcast is all about taking action. As always, if you’re looking to do a health checkup of your online visibility or your marketing, you can schedule a complimentary marketing strategy meeting with Ekwa Marketing at lessinsurancedependence.com/marketing-strategy-meeting. 

And secondly, if you’re looking for mentorship, book a complimentary coaching strategy meeting with Gary Takacs at thrivingdentist.com/csm. 

Now, both of these sessions will help you take real steps towards a stronger and more independent practice—and more importantly, they’re all complimentary.

So thank you for joining us. We look forward to seeing you in the next episode. Keep moving towards a stable and independent practice.