Sierra Smile Studio: The Website, the Investor, and the Per-Procedure Pay
Sierra Smile Studio is a Nevada LLC in which an investor holds 55% of the membership interests; the remaining 45% belongs to Dr. Amari, who provides all clinical care and is paid 30% of collections. The investor also owns a marketing company that is paid 15% of the revenue from each new patient it delivers through a call center. The website advertises "Board-Certified Implant Specialist on staff," "Painless dentistry - guaranteed," and "$39 new-patient exam and X-rays (regular value $410)," plus a monthly drawing in which "one lucky patient wins a free implant." A newspaper directory lists Dr. Amari, a general dentist with no specialty credential, under "Prosthodontics." The hygienist receives $5 per fluoride varnish and $20 per quadrant of scaling and root planing. Dr. Amari is uneasy and asks what has to change before the next ad cycle runs on Monday.
1. Evaluate each advertising claim against Nevada's standards for dental advertising and specialty announcement.
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Advertising must be truthful, not misleading, and identify the licensed dentist responsible; specialty claims are restricted to credentials the Board recognizes.
- "Board-Certified Implant Specialist on staff." Implant dentistry is not a Board-recognized dental specialty, so there is no specialty board credential that supports "specialist" in that sense. If the phrase means a continuing-education certificate, saying so is fine; implying a specialty status is not. The claim must be removed or rewritten to describe the actual credential accurately.
- "Painless dentistry - guaranteed." A guarantee of a clinical result is the classic prohibited advertisement. It is inherently misleading because no dentist can guarantee absence of pain, and it will be read as an assurance about outcomes.
- "$39 exam and X-rays, regular value $410." Discount advertising is permitted only if the comparison is bona fide. If $410 is not the practice's actual usual fee, the reference price is fabricated. The ad must also state what the $39 includes and that further treatment is charged separately, so the offer is not a bait price.
- Free-implant drawing. Beyond the inducement problem, a prize drawing tied to purchasing services raises sweepstakes/lottery questions and should be dropped rather than papered over.
- Directory listing under "Prosthodontics." Dr. Amari is a general dentist. Listing under a specialty heading is a direct misrepresentation and must be corrected with the publisher in writing; the same rule applies to letterhead, signage, and directory listings, not just the website.
2. Analyze the ownership and compensation arrangements, and describe a structure that would comply.
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Three separate compensation problems exist, and each is independently curable.
1. Non-dentist majority ownership. Nevada restricts the ownership of a dental practice to licensed dentists; a 55% investor stake in the professional entity is the core corporate-practice problem, whatever the operating agreement says about clinical control. Clinical control retained by Dr. Amari does not fix ownership of the entity that renders and bills for dental services.
2. Percentage-of-collections payments to non-dentists. Paying the investor 30% of collections, and the investor's marketing company 15% of new-patient revenue, is fee splitting: unlicensed parties are being paid a share of professional fees rather than a fixed price for identifiable services. Percentage-of-revenue marketing arrangements are a common trap because they look like ordinary sales commissions.
3. Per-procedure pay to the hygienist. $5 per varnish and $20 per quadrant of scaling rewards volume in procedures where the clinical question is need, not throughput, and it invites overtreatment and upcoding.
A compliant structure: the professional entity is owned by licensed dentists; the investor is recast as a landlord or lender at documented fair market value; management and marketing services are billed at a fixed fee or hourly rate supported by a fair-market-value opinion, with no percentage of professional fees and no percentage of collections; the hygienist moves to salary or hourly pay; and the advertising is reviewed before publication, with the specialty claims removed and the fee offer substantiated. Dr. Amari should not rely on the investor's lawyer for this review.
3. Dr. Amari is paid 30% of collections and believes that makes the ownership problem the investor's responsibility. Is that position defensible before the Board?
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No. The Board licenses dentists, not investors, so the exposure lands on the licensee whose name is on the charts and the claims. A dentist who practices inside an unlawfully structured entity, signs claims generated by it, and accepts compensation computed from those claims is participating in the arrangement even if someone else designed it.
The practical consequences run in several directions at once: discipline for aiding unlicensed practice or fee splitting, depending on how the Board characterizes the arrangement; billing exposure if claims were submitted by an entity not entitled to bill; and personal civil exposure to the investor if the structure collapses. "I only did the dentistry" is a mitigation argument about relative culpability, not a defense.
The defensible move is proactive: document what Dr. Amari knew and when, demand the restructuring in writing, refuse to sign new marketing or management agreements that carry percentage-of-collections terms, and if the investor will not restructure, plan an orderly exit with counsel. If the Board later asks why the dentist stayed, a dated written objection and a restructuring demand is the difference between being seen as a participant and being seen as a licensee who discovered a problem and acted on it.