Received Event (Event Succeeded) Date: 12/2/2004 Time: 2:16 PM Pages: 13 Duration: 3 min 25 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax DEC-@2-2804 14°14 AHCA/LEGAL MEDICAL ~ 853 414 1989 - STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, an - ; Uf -YAOP PETITIONER, ( UY WC L vs. CASE NUMBER: 2003-12585 MARTIN MEGREGIAN, D.D.S., RESPONDENT. ee ADMINI MPI COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Dentistry against the Respondent, Martin Megregian, D.D.S., and in support thereof alleges: 1. Petitioner Is the state department charged with regulating the practice of Dentistry pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 466, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed dentist within the State of Florida, having been issued license number DN 7462. P.@2 Received Event (Event Succeeded) Date: 12/2/2004 Time: 2:16 PM Pages: 13 Duration: 3 min 25 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax DEC-@2-2084 14:14 AHCA/LEGAL MEDICAL esa 414 1989 P.@3 we 37 Respondent's last known address of record is 4245 N. Courtney Parkway, Ste. C, Merritt Island, Florida 32953. 4, The Respondent at all times material to the events In this complaint, was the owner/operator of the “Martin Megregian and Associates” dental clinic which has an office located at 1805 Miccosukee Commons Drive in Tallahassee, Florida. Patient S.L., a minor, along with her parents W.L. and P.L., were provided dental care and treatment at the Respondent's Tallahassee office from on or about March 5, 2001, through on or about April 16, 2002. 5. Patient S.L. initially presented to the Respondent's clinic on March 5, 2001, for a general exam and x-rays. Patient $.L’s treatment record dated March 5, 2001, lists a child prophylaxis (cleaning) as being provided. No other exam findings, diagnoses, treatment planning, medical history or any other diagnostic notations are contained on the copy of Patient S.L.’s treatment record which was provided by the Respondent's clinic. The treatment record !s not signed or initialed for this visit. 6. Onor about October 6, 2001, Patient S.L. was seen at the Respondent's clinic again. Respondent's clinic billing records for that Received Event (Event Succeeded) Date: Pages: Sender: Fax Number: Type: DEC-@2-2884 14:15 12/2/2004 Time: 2:16 PM 13 Duration: 3 min 25 sec 850 414 1989 Company: Subject: Fax visit indicate Patient S.L. received a child prophylaxis and a fluoride treatment. The Respondent's clinic treater did not prepare any dental treatment notes to show any further diagnosis or findings during the October 6, 2001 treatment visit of Patient S.L, and the treatment record is not signed or initialed for this visit. . 7. On or about November 10, 2001, Patient S.L. was seen again at the Respondent's clinic. Respondent's clinic billing records for that visit indicate Patient S.L received a filling in tooth number 18. The Respondent's clinic treater did not prepare any dental treatment notes to show any further diagnosis or findings covering the November 10, 2001 treatment visit of Patient S.L. The terse record states “pt did not want to cooperate” and the treatment record is not signed or initialed for this visit. 8. Qn or about March 5, 2002, Patient S.L. was seen again at the Respondent's clinic. Respondent's dinic billing records for that visit indicate Patient S.L. received a periodic oral evaluation, bitewing x-rays, a bleaching kit, and a full mouth debridement with medicinal irrigation application, Full mouth debridement with medicinal irrigation AHCA/LEGAL MEDICAL. ; 850 414 1969 Received Event (Event Succeeded) Date: 12/2/2004 Time: 2:16 PM Pages: 13 Duration: 3 min 25 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax _ DEC-@2-2084 14:15 AHCA/LEGAL MEDICAL ~~ 858 414 1989 P.@5 , cary is a treatment regime used to treat patients with diagnosed periodontal (gum) disease. 9. The Respondent’s clinic treater did not prepare any dental treatment note or records covering the March 5, 2002 treatment visit of Patient S.L. to document or diagnose that Patient S.L. had periodontal problems, The radiographs billed during the March 5, 2002 visit were not explained or documented in any way to support a diagnosis of any findings from those x-rays. 10. Approximately one manth later, on or about April 16, 2002, Patient S.L. was seen at the Respondent's clinic again. Respondent's clinic billing records for that visit indicate Patient S.L. received an adult prophylaxis (cleaning). Respondent's clinic treater made a terse dental treatment record entry for Patient S.L. on April 16, 2002, nating a “child prohpy w/fluoride.” The Respondent's clinic treater did not prepare any dental treatment notes to show any further diagnosis or findings during the April 16, 2002 treatment visit of Patient S.L. and the treatment record is not properly signed to Identify the treating dentist for this visit, Received Event (Event Succeeded) : _ Date: 12/2/2004 Time: 2:16 PM Pages: 13 Duration: 3 min 25 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax _ DEC-@2-2664 14:15 AHCA/LEGAL MEDICAL 858 414 1989 P.B6 1f. Respondent's clinic treater did not make any notations to explain why Patlent S.L. was billed for receiving an adult cleaning six months after having a child’s cleaning in October 2001, or why she received a full mouth debridement periodontal treatment-on March 5, 2002, just a month prior to the adult cleaning, 12. The Respondent's clinic treater did not record an overall written comprehensive diagnosis, periodontal diagnosis, prognosis of treatments, or overall medical history for Patient S.L. during any of the treatment visits of Patient S.L. Respondent's clinic provided treatments in excess of established standards and without support in the records to document medical necessity for extensive medicated periodontal treatment on a child. A dentist or dental clinic that provides excessive or medically unnecessary dental treatment or treatment not supported by any dental treatment records Is providing treatment which fails to meet the minimum standards of dental performance. 13. Respondent's dental clinic records for Patient 5.L. do not accurately record or justify the course of Patient S.L.’s treatment, in that the Respondent's clinic notes did not document a diagnosis from Received Event (Event Succeeded) Date: 12/2/2004 Time: 2:16 PM Pages: 13 Duration: 3 min 25 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax DEC-62-2604 14:15 AHCA/LEGAL MEDICAL any x-rays prior to periodontal dental treatment procedures being performed on the patient. The Respondent's clinic notes for Patient S.L. also failed to contain an overall comprehensive written diagnosis, periodontal diagnosis, treatment plan and prognosis as part of the treatment records for Patient S.L. 14, From late November 2001 through May 2003, the parents of Patient S.L., W.L. and P.L., recelved numerous billings from the Respondent's office for services rendered to another “Patient $.L.” - who had the same name as Patient S.L. Despite numerous attempts by W.L. and P,L. to have the erroneous billings removed from their account, the Respondent's office sent several of the erroneous billings to credit collection agencies, 13. On or about June 16, 2003, subsequent to a records request from P.L. and W,L., P.L. and Patient S.L, appeared at the Respondent's dental office to pick up the family’s dental records and x- rays. At that time, Respondent's billing manager told P.L. and Patient S.L. that the records could not be released until they paid in full the erroneous billings for the other “Patient S.L.” which still showed as outstanding amounts due on their account. Those erroneous billings 85@ 414 1989 Received Event (Event Succeeded) Date: Pages: Sender: ” DEc-a2-2024 14:17 Time: 2:16 PM ooo Duration: 3 min 25 sec 850 414 1989 Company: AHCA/LEGAL MEDICAL 852 414 1989 performing periodontal dental treatment Procedures on the patient. The Respondent's clinic notes also failed to contain an overall comprehensive written diagnosis, periodontal diagnosis, treatment plan and prognosis covering any of the visits for Patient S.L. The Respondent’s clinic notes also failed to contain an overall medical history and teeth charting for Patient S.L., contained only terse illegible entries for the services rendered on each of Patient S.L’s visits, and were not properly signed or initialed to record the treating dentist of record, 19. Based on the foregoing, the Respondent has violated Section 466.028(1)(m), Florida Statutes (2000-2001), by failing to keep written dental and medical history records justifying the course of treatment of the patient. COUNT IT 20. The Petitioner re-alleges the allegations contained in Paragraphs one (1) through fifteen (15) as if fully incorporated herein. 21. Section 466.028(1)(ff), Florida Statutes (2000-2001), states that operating or causing to be operated a dental office in such’ a manner as to result in dental treatment that is below 12 -12 Received Event (Event Succeeded) _ Date: 12/2/2004 Time: 2:16 PM Pages: 13 Duration: 3 min 25 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax _ DEC-@2-2804 14:16 RHCA/LEGAL MEDICAL . 850 414 1989 P.Be for the other Patient S.L. were not cleared from W.L. and P.L’s Mh account until late June of 2003, after this complaint was filed, COUNTI 16. Petitioner re-alleges the allegations contained in paragraphs one (1) through fifteen (15) as if fully incorporated herein. mh 17. Section 466.028(1)(m), Florida Statutes (2000-2001), as ‘ implemented by Rule 64B5-17.002, Florida Administrative Code ve (F.A.C.), states that failing to keep written dental records and medical history records justifying the course of treatment of the patient including, but not limited to, patient histories, examination results, test results, and x-rays if taken, shall constitute grounds for disciplinary action by the Board af Dentistry. Section 466.018(2), Florida Statutes (2000-2002), states that if a dentist of record is not identified in the patient record as required it shall be presumed as a matter of law that the dentist of record is the owner of the dental practice in which the patient was treated. 18. Respondent’s dental clinic records for Patient S.L. failed to justify the course of Patient S.L.’s treatment in that the Respondent's clinic’ notes did not document diagnosis from any x-rays prior to Received Event (Event Succeeded) Deen named Date: 42/2/2004 Time: 2:16 PM Pages: 13 Duration: 3 min 25 sec Sender: 850 414 1989 Company: Fax Number: Subject: ne Type: Fax DEC-@2-20@4 14:16 AHCA/ZLEGAL MEDICAL 85a 414 1989 P.a9 minimum acceptable standards of performance for the community, to include, but not limited to, the use of substandard materials or equipment, the Imposition of time limitations within which dental procedures are to be performed, or the failure to maintain patient records as required by this chapter, shall constitute grounds for disciplinary action by the Board of Dentistry. 22. The Respondent's ctinic failed to meet minimum standards of dental performance in diagnosing and treating Patient S.L. in one or more of the following ways: a) By failing to document why prophylaxis and related treatments in excess of established standards were performed on Patient S.L,; b) By failing to document medical necessity for performing extensive medicated periodontal treatment on a child (Patient S.L.) within months of having performed a routine cleaning with no records of any periodontal problems at the time of the cleaning; c) By performing prophylaxis and related treatments In excess of established standards on Patient S.L.; d) By performing extensive medicated periodontal “ treatment on a child (Patient S.L.) without any “ indication of medical necessity for such treatment; . @) By failing to adequately document any clinical or radiographic examination findings for Patient S.L.; Received Event (Event Succeeded) _ Date: 12/2/2004 Time: 2:16 PM Pages: 13 Duration: 3 min 25 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax _ DEC-@2-2004 14:16 AHCA/LEGAL MEDICAL. 858 414 1989 P.18 ~ thereby failing to establish a basis supporting the treatments provided to Patient S.L. 23. Based on the foregoing, the Respondent has violated Section 466,028(1)(ff), Florida Statutes (2000-2002), by operating or causing to be operated a dental office in such a manner as to result in dental treatment that is below minimum acceptable standards of performance for the community. COUNT ITI 24. The Petitioner re-alleges the allegations contalned In paragraphs one (1) through fifteen (15) as if fully incorporated herein. 25. Section 456.057(4) and Section 466.028(1)(n), Florida Statutes (2002), as implemented by Rule 6485-17.009(3), F.A.C., require a practitioner to Supply within 30 days of request, a complete copy of records to any patient who has so requested and pald reasonable fees for such a service. The release of records requested cannot be made contingent upon payment of any billings past due from the patient. 26, On or about June 16, 2003, P.L. and Patient S.L. appeared at the Respondent's dental office to pick up the family’s dental records and x-rays pursuant to a May 26, 2003 records request made by PLL. 10 10 Received Event {Event Succeeded) _ Date: 42/2/2004 Time: 2:16 PM Pages: 13 Duration: 3 min 25 sec Sender: 85C 414 1989 Company: Fax Number: Subject: Type: Fax _ DEC-@2-2804 14:16 AHCA/LEGAL MEDICAL ; 858 414 1989 P.it and W.L. Respondent's billing manager told P.L. and Patient S.L. that the records could not be releascd until they paid in full erroneous billings for another “Patient S.L” with the same name as their daughter S.L. Those disputed billings still showed as outstancling amounts due on their account. The Respondent's clinic failed to timely DF produce or otherwise respond to the patient's request for all treatment records by allowing his staff to condition reléase of the records upon payment of outstanding billings which were in dispute. 27. Based on the foregoing, the Respondent has violated Section 456.057(4) and Section 466.028(1)(n), Florida Statutes . (2002), as implemented by Rule 64B5-17.009(3), F.A.C., which require @ practitioner to supply within 30 days of request, a complete copy of a patient's treatment records. WHEREFORE, the Petitioner respectfully requests that the Board of Dentistry enter an order imposing one or more of the ‘ “ following penalties: revocation or suspension of the Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, 11 11 Received Event {Event Succeeded) Date: 12/2/2004 Time: 2:16 PM Pages: 13 Duration: 3 min 25 sec Sender: 850 414 1989 Company: 7 Suhiact: Fax Number c-22-2004 14:17 RHCA/LEGAL MEDICAL 858 414 1989 P.13 Tyk _ ~ ~ OR corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. 7) SIGNED this A> day of Mn vA , 2004. John 0. Agwunobi, M.D., M.B.A. Secretary, Department of Health FILED | T OF HEALTH , DEPARTMENT OF Waype Qh cpenK Lod, Columnaa. Wayne Mitchell 7 Assistant General Counsel oaTe_S- DOH Prosecution Services Unit 4052 Bald Cypress Way Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar #869414 (850) 414-8126 FAX: 488-1855 Reviewed and approved by: Dezinitials) “fade (date) PCP: 5/24/ 0 . PCP Members: 4H,wR Cm POH vs. Martin Megregian, D.D.5., Case No, 2003-12585 12 ee ” TOTAL P.13 13 Received Event (Event Succeeded) Date: 12/2/2004 Time: 2:20 PM Pages: 1 Duration: 0 min 31 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax DEC~@2-284)4 14:18 AHCA/LEGAL MEDICAL _ 858 - NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other (ualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf If a hearing is requested. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the Investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. DOH vs, Martin Megregian, D.D.S., Case No. 2003-12585 414 1989 P.@1/61 TOTAL P.@41

Docket for Case No: 04-004330PL