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Legal Advocacy and Resources

The Division of Legal Affairs actively monitors and engages in legal issues that are important to or may affect ADA members and supervises litigation pertaining to ADA. ADA has filed three class action lawsuits against insurance carriers alleging federal and state law violations for improperly denied, delayed and/or reduced payment to dentists; undercut fees charged by "out-of-network" dentists without the data required to justify the reductions and a racketeering complaint against three of the nation's largest insurers alleging that they conspired to "deny, reduce and delay" lawful payments to dentists under contract to the plans.

Quick Links: Law & Ethics

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ADA also offers support to dentists and states facing legal challenges by way of friend of the court (amicus curiae) briefs. In 2008, ADA filed amicus curiae briefs in 4 important lawsuits.

  • In Met Life et al v. Glenn, ADA's amicus brief to the U.S. Supreme Court focused on the illegitimacy of the insurer's position that an ERISA plan administrator's dual function as evaluator of eligibility and payer of benefits only present a potential conflict of interest. ADA also advocated that a plan administrator should have minimal, if any, interference with the doctor's assessment of the patient given the fiduciary-type nature of their relationship.
  • In Sharpe v. Arizona Health Care Cost Containment System Administration, et al., ADA and the Arizona Dental Association argued to the state appellate court that the state's legislature mandated coverage for dentures when it is determined by a patient's doctors to be medically necessary and that a state agency cannot rely on an irrebuttable presumption that the inability to properly chew can never constitute a medical necessity and had no reasonable basis for overriding the conclusions of the patient's doctors.
  • In Rutt v. Anthem Health Plan and Connecticut State Dental Association v. Anthem Health Plan, ADA's amicus brief to a federal appeals court took the position that ERISA does not preempt state law claims of dentists and other health care providers that arise from their contracts with managed care plans but rather that ERISA preemption applies only against plan participants and beneficiary.
  • In Taylor v. Sturgell, ADA's amicus brief argued that the U.S. Supreme Court should affirmatively state that the virtual representation doctrine (privity) will not be applied simply because litigants in the second case are members of the same organization as a litigant in the first case. Specifically, an ADA member would not waive his or her day in court based on action by another member based only on joint professional association membership.

The Division of Legal Affairs protected the ADA in 2008 by issuing nearly 60 Cease and Desist letters concerning copyright infringement, including infringement of CDT and NBDE content, unauthorized use of the ADA name and logo, false claims of ADA endorsement, and misrepresentations concerning vendor status. The Division of Legal Affairs also completed over 192 fully executed CDT Licenses in 2008 with 25 additional licenses pending.

The Division of Legal Affairs serves as the ADA's key antitrust resource and compliance advocate. Antitrust Laws in Dentistry | PDF file/232k This image denotes ADA Members Only Content Link opens in separate window. Pop-up Blocker may need to be disabled. is an online primer that can help you achieve your objectives without creating undue antitrust risk. The ADA Contract Analysis Service offers members informational reviews of unsigned participating dentist contracts from managed care plans, at no charge, if the contracts are submitted through members' state dental associations. These reviews can assist you in making informed provider contracting decisions. In 2008, the ADA's Contract Analysis Service completed 129 analyses of unsigned managed care contracts. Additional legal resources available from the ADA Catalog Link opens in separate window. Pop-up Blocker may need to be disabled. include: Frequently Asked Legal Questions and Protecting Your Dental Office from Fraud and Embezzlement.

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