I Went to Prison Over Dental Billing & Compliance — 7 Steps to Protect Your Practice | Roy Shelburne, DDS

“It wasn’t intentional—but it changed everything.”

Out of $3.5 million in claims over six and a half years, just $17,899.57 was deemed improper.

The result?
He received a 24-month federal prison sentence.

In this powerful episode of Dental Office Rescue, Linda Kane sits down with Roy Shelburne, DDS — a nationally recognized speaker on dental documentation, billing, and compliance — to share the story behind his mission.

And that mission is deeply personal.

“I’m passionate about being the last dental professional who goes to prison for things they didn’t know or understand. Ignorance is no excuse. I’m the crash dummy. I’m the one that went through the process and learned the hard way that there are things we can do to protect and defend our practices.”

This isn’t a story about intentional fraud.

It’s a story about what happens when documentation systems, compliance protocols, and audit processes aren’t in place — even when you believe you’re doing everything right.

It’s about what you didn’t know…
And why knowing now changes everything.

How Small Documentation Gaps Turn Into Major Legal Exposure

One of the most important lessons from Roy’s experience is this:

There is no such thing as an innocent mistake in the eyes of the law.

Roy explains the legal concept of “blind disregard.”
If a practice repeatedly submits claims without a system to identify and correct errors, that can legally be interpreted as intent — even if the mistakes were never deliberate.

That means:

• Not reviewing clinical notes before claims are submitted
• Not signing documentation properly
• Not having internal audits in place
• Inconsistent coding practices
• Waiving copays or misreporting fees

All of these create risk — especially if your practice accepts any form of government reimbursement (Medicaid, Medicare, federal employee plans, ACA plans, military dependents).

In today’s environment, insurance companies are using AI to identify outliers. If your coding patterns fall outside statistical norms, it can trigger scrutiny.

It’s no longer just about whether something was intentional.

It’s about whether you had systems in place.

The 7-Step Compliance System Every Dental Practice Needs

Roy outlines a structured, mandated 7-step compliance program that removes “blind disregard” from the equation and protects your practice.

Here’s what it includes:

1. Commit to implementing an audit system
2. Establish clear documentation and billing standards
3. Assign a compliance leader in your practice
4. Train your team consistently (not just once)
5. Create open feedback channels between team and doctor
6. Identify errors and implement corrective systems
7. Remove team members who refuse to meet standards after training

This isn’t about fear.
It’s about protection.

When documentation tells the beginning, middle, and end of the story…
When notes are signed…
When coding reflects exactly what was done…
When systems exist to catch errors…

You dramatically reduce risk.

Why “I Didn’t Know” Isn’t a Defense

Roy says it clearly:

Ignorance is no excuse.

Many dentists believe, “That would never happen to me.”

Roy believed that too.

His practice had strong patient relationships. He was busy. He wasn’t trying to cheat the system. In fact, the error rate determined by the government was less than one-tenth of one percent.

But without a compliance system to identify and correct errors, the legal interpretation changed everything.

The takeaway?

The choice to implement systems — or ignore them — is still yours.

Protecting More Than Just Revenue

This episode isn’t about scare tactics.

It’s about protecting:

• Your license
• Your practice
• Your team
• Your family
• Your future

Compliance isn’t just a regulatory requirement.
It’s leadership.

When you build systems that protect your practice, you reduce stress, strengthen team clarity, and create stability in an increasingly audit-driven industry.

Listen to the Full Episode

If you accept any type of government reimbursement — or if you simply want to strengthen your documentation and billing systems — this episode is essential listening.

Roy shares his story with honesty, humility, and a commitment to make sure no other dental professional has to learn the hard way.

🎧 Listen to the full episode of Dental Office Rescue now.

Connect & Learn More

Follow Roy Shelburne, DDS for compliance education and speaking engagements:
Facebook: https://facebook.com/royshelburne