Difficult Patients: How Dentists Actually Get in Trouble (and How to Protect Your License) — Part 2 with Evan Sampson

In Part 2 of this two-part conversation, we move from theory into the real-world details that quietly put dentists at risk every single day.

My guest, Evan Sampson, is a healthcare attorney who has served as general counsel to one of the largest dental support organizations in the country. He brings a rare and invaluable perspective at the intersection of dentistry, law, payer audits, and regulatory enforcement — and in this episode, we get very specific.

We unpack what actually makes certain procedures, CDT codes, and clinical scenarios high-risk from a fraud, waste, and abuse standpoint, even when there is no malicious intent. Evan explains how dentists inadvertently get flagged as outliers, why payer audits are often data-driven rather than complaint-driven, and how documentation gaps — not clinical skill — are what ultimately create exposure.

This conversation goes deep into:

• Why up-coding, unbundling, and weak surgical extraction documentation are some of the most common (and expensive) pitfalls

• How payer audits are triggered, what auditors look for, and why Medicaid claims carry disproportionate risk

• Why dentists should write progress notes as if a regulator, payer, or board investigator will read them later — because one day, they might

• The legal realities of fee-for-service, out-of-network billing, professional courtesy, discounts, and when "good intentions" can still create compliance problems

We also spend significant time on a topic every dentist encounters but few are trained to manage: difficult and high-risk patients.

Evan shares how to identify red flags that may not be obvious at first, when it is appropriate to terminate the doctor-patient relationship, and how to do so without exposing yourself to allegations of abandonment. We discuss unruly patients, non-payment, mid-treatment dismissals, refunds, releases, and why protecting your license sometimes means making uncomfortable — but strategic — decisions.

This episode is ultimately about risk reduction, professionalism, and self-preservation. Not practicing defensively, but practicing deliberately. Tightening the details. Building a culture of compliance. And understanding that most dentists who get into serious trouble never thought they were doing anything wrong.

If you care about protecting your license, your livelihood, and your future — this is an episode you don't want to skip.