ࡱ> =?<%`  bjbjNN ;",, 2|||8y*$ h #~fff3ff4\ `f9 :|LI0yT##\\P#Ly|dY @dyffff    May 6, 2009 David Wales, Acting Director Bureau of Professional Competition Federal trade Commission 600 Pennsylvania Ave. @ 6th St., N.W. Washington D.C. 20580 (202) 326-3300 Re: Possible violations of the FTC, Clayton, and McCarran-Ferguson Act Dear Mr. Wells: We understand that at least two 3rd party payors are profiling and flat-out denying reimbursement claims from dentists, not based on their claim form submission and any narratives or descriptors, but merely having been identified as LANAP practitioners. LANAP is a gum disease treatment alternative is called laser assisted new attachment procedure (LANAP) and is FDA cleared 510(k)030290. Please see attached letter from Delta Dental of Tennessee to periodontist Dr. Michael Skinner. It appears that Delta Dental is in violation of the Acts provision not to boycott, coerce or intimidate. The act's exemption applies only if three conditions are met: The insurer's action pertains to "the business of insurance" The action must be regulated by state law The action must not be designed to "boycott, coerce or intimidate" Dr. Skinner is merely offering a professional serve for the treatment of gum disease that is less costly to consumers, with less morbidity, which improves access to care for this serious disease with negative effects on a persons systemic health as well. We are also reasonably informed and reliably believe that a conspiracy exists between the American Academy of Periodontlogy (AAP) and Delta Dental to reduce competition among those dentist who offer LANAP and those who do not. Specifically, the AAP is representing that a LANAP surgical procedure submitted to a 3rd party payor, is insurance fraud. Dr. Dave Preble of the ADA Council on Nomenclature assures us this is not the case, however, the ADA has not put that into writing. Perhaps this is because two AAP members sit on that Council. I have received correspondence from an anonymous AAP member who wrote, Insurance fraud Message: I had a nice conversation with Pat Throe the Academy of Periodontolgy today, she is the insurance liaison for the academy. Pat gave me an earful of the word fraud when I asked her about LANAP. It may be the next thing since sliced bread but the academy is vigorously defending patients and periodontists with insurance carriers against practioners of LANAP. The position of the Insurance carriers is that the 4260 code is not LANAP. The carriers will not reimburse practitioners who file a claim with an insurance company claiming to have done osseous surgery when LANAP has been performed. That if a practitioner files a claim for 4260 when LANAP has been performed fraud has taken place. That is the AAP's position not mine. To offset the fraud claim the AAP reccommends a narrative stating a laser was used to perform the 4260 osseous surgery. Then it is up to the insurance carrier to make the decision to pay the claim. We would appreciate any intervention that you may provide. Sincerely, Robert H. Gregg, DDS     David Wells April 6, 2009 Page Two  ,hl     0 2 c q f g O P W ݴɚ璴|ujfbbhqh9h9h^PXB*ph h9he he\ h9\heheH*hehehe\h9h^PXB*\phheheB*\ph heheh9h9B*H*\phheB*\phhqB*\phh9B*\phh9h9B*\phh95B*\ph& ,Oh  g O  & Fdd[$\$gd^PX & Fd[$gd^PXgdegd^PX O O P 34tuvwxz{|gde5Qstux"x{|    ͽ㇋hDhu`Cjhu`CU h9hFhFheB*ph%he5B*CJOJQJ\aJphheB*CJOJQJaJphheheCJOJQJaJ heheh(1hhUc#hehqhqhqH*&    9 0&P1h:p(1/ =!"#$% @@@ NormalCJ_HaJmH sH tH DA@D Default Paragraph FontRiR  Table Normal4 l4a (k(No ListLOL ^PXiii-mhl1#5CJOJQJ\^JaJo(ph@O@ ^PXiii-big1CJOJQJ^JaJo(4@4 eHeader  !4 @"4 eFooter  ! 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