What Dentists Need To Know About Surcharges For Personal Protective Equipment
Jordan Uditsky • July 30, 2020
When dental practices reopened their doors and resumed seeing patients, they did so in a world that, for all of its familiarity, remains dramatically different than it did before the pandemic consumed American life. Among the myriad new issues that practices needed to confront was the imperative of ensuring the health and safety of their patients and staff. But doing so requires more than modified protocols and procedures. It involves a significant investment in the resources necessary for infection prevention and control, including personal protective equipment (PPE).
While dentists and technicians already incurred significant costs in safety gear pre-pandemic, it is estimated that PPE costs for dental practices are now ten to thirty times higher than they were a few short (or long) months ago. This compounds the challenges faced by practices already reeling from an extended period of lost revenues.
To deal with these additional costs, many dental practices are adopting an approach taken by other businesses such as restaurants and salons by charging surcharges for the costs of PPE. While there is nothing inherently problematic in such charges, which can range from $10 to $40, the way practices notify patients about them and how they seek reimbursement from insurance carriers can raise some tricky issues.
The ADA’s Guidance on Documenting Surcharges
The American Dental Association (ADA) has firmly supported the decisions of practices to impose a surcharge for PPE if they so choose, though it does not provide fee guidance. The ADA recommends
that those practices that do impose a surcharge do so transparently and consistently: “It is always best to inform patients of any additional charges to avoid any surprise bills. Providing a documented financial policy and seeking consent is desirable.”
As to how best to document charges related to PPE, the ADA advises dentists to develop a standard office policy to document the specific PPE that will be used across all patients. Alternatively, the ADA recommends that dentists add a note in the patient’s record to document the details of the PPE uniquely necessary for the visit when charging different fees based on the level of PPE used.
Coding, Billing, and Reimbursement
In its April 2020 Statement on Third Party Payer Reimbursement for PPE, the ADA urged third-party benefit programs to either:
• Adjust the maximum allowable fees for all procedures, or
• Allow a standard fee per date of service per patient to accommodate the rising costs of PPE.
Prior to such adjustments taking effect, the ADA suggests that dental offices use CDT code “D1999 - unspecified preventive procedure, by report” to document and report the use and costs for additional PPE.
The ADA has also issued extensive guidance for third-party PPE coding and billing. The guidance includes a regularly updated list and outline of the specific policies that various carriers have announced.
Renegotiating Fee Schedules
The additional costs of practicing during the pandemic era and the need to cover those expenses in ways that minimize the amount passed on to patients may require practices to renegotiate their fee schedules with the dental benefit plans for which they are a participating provider.
Before attempting to renegotiate with a carrier, practice owners should be familiar with and have at the ready a range of facts and figures about their practice they can use to make their case for an adjustment. Regarding coronavirus and PPE-related charges specifically, you should know the added per-patient expense you incur for those expenses. You can break these costs down into added disposable PPE costs per patient, as well as added per-patient estimates to recover engineering controls.
Experienced Dental Practice Counsel During An Unprecedented Time
These are indeed unprecedented times for dentists and dental practices. The challenges of maintaining a viable practice while also bearing the new costs required to ensure patient and staff safety can be overwhelming. That is why it is so critical for dental practice owners to have the business and legal resources they need to help them navigate the uncharted waters of this new era.
At Grogan, Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as for orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We understand the concerns and complexities faced by owners and practitioners as the pandemic remains a dominating presence in their practices. We welcome the opportunity to assist you during these unique and difficult times.
Please call us at (630) 833-5533 or contact us online to arrange for your free initial consultation.
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Bogus ADA Claims Regarding Dental Practice Websites Are Rampant. Your Lawyer Can Help You Tell the Difference Between a Real Problem and a Real Shakedown. Over 25 years have passed since the Americans with Disabilities Act (ADA) quite literally reshaped the landscape for people with disabilities. From building entrances to parking lots to restrooms to elevators, from hiring and employment opportunities to restaurants, stores, and websites, disabled Americans have far greater access to the same facilities, services, and opportunities as everyone else. Harassment at Best, Extortion at Worst For all the good it has accomplished, however, the ADA has also been abused by opportunistic individuals and attorneys who have used the law in bad faith to shake down small businesses, including dental practices, for alleged violations that have not actually caused any harm or infringed upon any rights afforded by the act. These self-appointed ADA compliance "testers" have filed thousands of nuisance ADA suits that have cost American businesses millions of dollars. According to one analysis, ADA lawsuits have increased by 320% since 2013, with over 4,000 suits filed in 2024 alone. Many plaintiff's law firms file hundreds of cookie-cutter ADA lawsuits each year. One person can visit multiple businesses or websites in a single day solely to identify even the slightest accessibility transgressions in order to generate claims. While these suits can focus on any number of alleged ADA shortcomings, those relating to website accessibility (discussed in detail in this earlier post ) filed by a handful of law firms and serial plaintiffs have earned the scorn of small businesses and practices across the country. That's because these "testers" and the lawyers who represent them specifically target small businesses, as they typically have limited means to defend themselves, may not be able to discern between legitimate and bogus claims, and often see a quick payoff as the path of least resistance. Here’s how the shakedown typically goes down: A plaintiff or their attorney sends the practice a demand letter in which they claim that the practice’s website is inaccessible to people with disabilities (e.g., missing image alt text, inaccessible forms, incompatible with screen readers). They cite a violation of Title III of the ADA. They make a demand for a cash settlement, often ranging from $2,500 to $25,000, alongside a request for accessibility fixes. The business/practice cuts a check in exchange for a release of any ADA claims by that plaintiff related to the website. The business/practice may then receive more demand letters, often from the same firm, on behalf of other plaintiffs who make the same claim, and the extortion continues. Don’t Act Impulsively – Do This Instead All this is not to say that dental practice owners should consider all such claims and demands to be frivolous or ignore their ADA obligations relating to their website. To be sure, a meritorious ADA lawsuit can indeed expose a practice to significant financial and reputational damage. Before reflexively giving in to an ADA demand letter and settling a supposed claim, practice owners should take the following steps: · Don't Panic, But Don't Ignore It. As noted, a demand letter with legalese and ominous language doesn’t mean that you’ve done anything wrong or actually violated the law. While your immediate reaction may include fear, confusion, or anger, don’t act impulsively. By the same token, don’t assume it is a bogus threat; crumble up the letter and throw it in the recycling. Deadlines in these letters are real, and failing to respond appropriately to a viable claim could lead to litigation. · Contact Your Attorney Immediately. This is not a DIY situation. Before responding to the letter or contacting the sender, consult with an attorney experienced in ADA compliance and website accessibility issues. Your lawyer can evaluate the demand letter or complaint, the validity of the claim, and the law firm behind it before formulating an appropriate response. Testers send many cookie-cutter letters that may contain boilerplate allegations of deficiencies that do not actually exist. · Evaluate Your Actual Compliance. Work with your attorney and website accessibility experts to have your website assessed against the Web Content Accessibility Guidelines (WCAG) , which courts often reference in ADA website cases. Understanding your site's actual accessibility helps inform whether settlement, remediation, or another approach makes sense and whether you need to take additional steps to avoid future claims. Keep in mind that this isn't just about legal compliance—it's good business. An accessible website serves all patients better and demonstrates your commitment to inclusivity. If you have questions about your business's ADA obligations and how to protect it from accessibility complaints, please call Grogan, Hesse & Uditsky at (630) 833-5533 or contact us online to arrange for your free initial consultation. At Grogan Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices. This blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
For employers and employees alike, in workplaces from restaurants to factories to dental practices, the specter of a visit from ICE, CBP, or other federal immigration forces looms large. Trepidation and fear are common feelings in this perilous climate, exacerbated by uncertainty as to one’s rights and how to respond when militarized agents arrive at a workplace. For dental practice owners, protecting their employees, patients, and business is a top priority, as is doing so in a legal, peaceful, and effective manner that doesn’t make a difficult situation worse. That is why it is so critical that you understand your rights and obligations in the face of such intrusions. While you should absolutely and immediately contact counsel if immigration agents show up at your practice, here is some practical guidance to help keep you and your employees safe. Different Responses to Different Types of ICE Actions Historically, ICE has conducted three types of workplace actions: I-9 audits (Notice of Inspection or “NOI”), which are administrative reviews of employment eligibility verification forms; worksite enforcement operations, which may include arrests; and searches pursuant to a warrant. Unfortunately, these customary practices have recently expanded to include warrantless, legally unauthorized, and sometimes violent entry into workplaces. The type of action the agency takes determines your obligations and your rights. An I-9 audit begins with a formal notice, typically giving you three business days to produce your I-9 forms and supporting documentation. A worksite enforcement operation or raid, however, often comes without warning. Understanding which situation you're facing is the critical first step. When ICE Arrives Without Notice – Keep Calm, Call Your Lawyer, and Ask For Authority If ICE agents appear at your workplace without prior notice, remain calm and follow these essential steps: · Keep calm , and don’t make any quick or impulsive decisions. Politely ask the agents to wait while you contact your attorney. You are not required to let agents enter non-public areas of your workplace without proper legal authority. While agents can enter your reception area or other common spaces as any member of the public could, they cannot access private areas such as treatment rooms, back offices, lunchrooms, or labs without your consent, a valid warrant, or an emergency. · Ask to see credentials and any warrants or legal documents. Scrutinize these thoroughly and understand this crucial distinction: an administrative warrant (Form I-200 or I-205) is not the same as a judicial warrant signed by a judge. Administrative warrants alone do not give ICE the authority to enter your private property or detain individuals. A judicial warrant, however, must be honored, though you should still speak with your lawyer who can help verify that it's properly signed, dated, and identifies the correct location and individuals. · Designate a single point of contact , ideally yourself as practice owner or an office manager, to communicate with the agents. Instruct other employees not to answer questions or provide information without guidance. This prevents confusion and minimizes the chances of miscommunication or escalation. Understanding Your Rights Employers have constitutional rights that apply during ICE encounters. The Fourth Amendment protects against unreasonable searches and seizures. As noted, without a judicial warrant or your consent, ICE generally cannot enter private areas of your practice, search filing cabinets or computer systems, or detain employees based solely on their immigration status. You have the right to refuse consent to a search. Exercise that right. If agents don't have a warrant, you can politely but firmly state: "I do not consent to a search of the premises. If you have a warrant signed by a judge, I would like to see it and have my attorney review it." If they have a warrant, verify it carefully to check that the address is correct, the signature is from a federal judge (not an ICE officer), and it's dated recently. Despite the recent rhetoric and actions of ICE agents and officials, you have an absolute right to observe, record, video, and document what's happening and what the agents are doing, so long as you do not interfere with or impede their operations. If ICE does enter your practice, you or your designated representative has the right to, and should, accompany agents to witness their actions. Protecting Your Employees Your employees also have rights, regardless of their immigration status. They have the right to remain silent and do not have to answer questions about their immigration status, where they were born, or how they entered the country. They have the right to refuse to show documents beyond what's necessary to demonstrate identity, unless they're under arrest. They should not lie or present false documents, as this can create additional legal problems. Before an ICE visit occurs, consider holding a "know your rights" training for employees. Inform them that if ICE arrives, they should remain calm, not run, and not present false documents. Provide them with a card that includes information about their rights and the contact information for your practice's attorney. You should never lie to federal agents or provide false information. However, you are not required to volunteer information or answer questions beyond what's legally necessary. If asked about specific employees, you can politely decline to answer and refer agents to your attorney. Once ICE agents leave, immediately document everything that occurred and save any videos or recordings so you can send them to your attorney. Preparing Before ICE Arrives The best time to prepare for an ICE visit is before it happens. Consider the following proactive steps: · Develop a written policy for your practice that designates who will handle ICE encounters, what steps to take, and how to contact your attorney. · Conduct an internal I-9 audit to identify and correct any paperwork errors or gaps. · Train office managers and supervisors on the protocol. Everyone should know not to consent to searches, not to answer questions without guidance, and to remain professional and calm. Post "know your rights" information for employees in common areas. If you have any questions or concerns regarding ICE or immigration enforcement activities at your practice, please contact Grogan, Hesse & Uditsky today. We focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
Selling a dental practice is a lengthy and involved process that involves due diligence, negotiation, drafting, financing, and other elements, culminating in the seller handing over the keys to the business to the buyer. But the parties’ signatures on the final purchase agreement and ancillary documents hardly mean that the now-former owner can ride off into the sunset without a care in the world. That is because the purchaser will want and require the seller to be responsible for any undisclosed or undiscovered problems with the practice they just bought. For this reason, every dental practice purchase agreement will inevitably contain indemnification provisions that address what happens if problems emerge after closing. These clauses determine who bears the risk for post-closing discoveries and how much exposure each party faces. While the purchaser wants the assurances and protections that come from the contract’s indemnification provisions, the seller doesn’t want to make an open-ended, potentially limitless promise that could eviscerate the financial upsides of the transaction and leave them forever on the hook for millions of dollars in possible liability. That is why deal savvy dental practice attorneys usually require that the purchase and sale agreement’s indemnification provisions include “caps” and “baskets” that establish the maximum exposure a seller will face as well as the minimum amount that must be at issue before any indemnification obligations are triggered. Given the significance that these maximums and minimums have for both parties, it is critical that buyers and sellers understand how caps and baskets work and the best ways to protect their respective interests in a dental practice sale. It All Starts With the Seller’s Representations and Warranties In any dental practice sale, the seller makes certain representations and warranties about the practice and its current condition. These disclosures might include assurances that all patient records are accurate, all equipment is in good working order, the practice has no pending lawsuits or liabilities, all taxes have been paid, and certain personnel matters are in order. If any such representations prove to be false, the indemnification provisions give the buyer the right to seek compensation from the seller for any losses incurred. Liability Caps Establish the Seller’s Maximum Indemnification Exposure A liability cap limits the total amount a seller must pay for breaches of representations and warranties. In dental practice transactions, caps can range from 10% on longer transactions to 100% of the purchase price on practices trending below $1,000,000, with 25% to 50% being most common for middle-market acquisitions. Where the parties ultimately land as to that percentage is a factor of each party’s risk tolerance and the practice's characteristics. A well-established practice with meticulous records, abundant goodwill, and comprehensive due diligence might justify a lower cap. Conversely, a practice with a limited or checkered financial history or significant operational complexity might warrant a higher cap to protect the buyer. Most liability caps exclude certain matters for which the seller remains on the hook for an unlimited amount. Such issues can include overt fraud or fundamental misrepresentations regarding the seller's authority to sell the practice or having clear title to assets. Tax obligations, environmental issues, and employee-related liabilities might also receive special treatment with separate, higher caps than provided for other matters. Baskets Are Like Deductibles While caps address maximum liability, baskets establish minimum thresholds before indemnification obligations arise. Think of a basket like a deductible in an insurance policy. Just as an insured is responsible for paying amounts up to the deductible before the insurer’s obligations kick in, a basket establishes the threshold below which the purchaser must bear any costs or liabilities for post-closing problems, even for matters covered by the contract’s indemnification provisions. Dental practice sales typically include one of two basket types: · A “true deductible” basket provides that the buyer absorbs all losses until reaching the threshold amount, after which they are entitled to recover all sums above it. For example, with a $25,000 true deductible basket, if the buyer’s losses total $30,000, the seller pays only $5,000. · A “tipping” basket , sometimes called a dollar-one basket, provides that once the buyer’s losses exceed the designated threshold, the seller pays from dollar one. Using the same example, the seller would pay the entire $30,000 once that threshold is crossed. Basket amounts in dental practice sales typically range from $5,000 to $25,000, depending on deal size. A $500,000 practice might have a $5,000 basket, while a $3 million practice might see a $25,000 threshold, for example. How Caps and Baskets Impact the Parties After Closing These provisions significantly impact post-closing dynamics. A seller who negotiates a low cap and high basket will minimize their exposure, while a buyer who secures a high cap and low basket gains significant protection and reassurance. Since negotiations over indemnification caps and baskets aren’t conducted in a vacuum, a party that secures an advantageous cap and basket arrangement can expect more challenging negotiations when discussing other aspects of the transaction, such as a higher purchase price or less favorable payment terms. Unanticipated liabilities can wreak havoc for dental practice buyers and sellers alike long after the ink has dried on their agreement. Dentists on either side of a practice sale should work closely with experienced legal counsel to negotiate terms that strike an appropriate balance between protection and practicality. Contact Grogan, Hesse & Uditsky Today If you are a practice owner anticipating a sale or transition, please contact Grogan, Hesse & Uditsky today. We focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
Bogus ADA Claims Regarding Dental Practice Websites Are Rampant. Your Lawyer Can Help You Tell the Difference Between a Real Problem and a Real Shakedown. Over 25 years have passed since the Americans with Disabilities Act (ADA) quite literally reshaped the landscape for people with disabilities. From building entrances to parking lots to restrooms to elevators, from hiring and employment opportunities to restaurants, stores, and websites, disabled Americans have far greater access to the same facilities, services, and opportunities as everyone else. Harassment at Best, Extortion at Worst For all the good it has accomplished, however, the ADA has also been abused by opportunistic individuals and attorneys who have used the law in bad faith to shake down small businesses, including dental practices, for alleged violations that have not actually caused any harm or infringed upon any rights afforded by the act. These self-appointed ADA compliance "testers" have filed thousands of nuisance ADA suits that have cost American businesses millions of dollars. According to one analysis, ADA lawsuits have increased by 320% since 2013, with over 4,000 suits filed in 2024 alone. Many plaintiff's law firms file hundreds of cookie-cutter ADA lawsuits each year. One person can visit multiple businesses or websites in a single day solely to identify even the slightest accessibility transgressions in order to generate claims. While these suits can focus on any number of alleged ADA shortcomings, those relating to website accessibility (discussed in detail in this earlier post ) filed by a handful of law firms and serial plaintiffs have earned the scorn of small businesses and practices across the country. That's because these "testers" and the lawyers who represent them specifically target small businesses, as they typically have limited means to defend themselves, may not be able to discern between legitimate and bogus claims, and often see a quick payoff as the path of least resistance. Here’s how the shakedown typically goes down: A plaintiff or their attorney sends the practice a demand letter in which they claim that the practice’s website is inaccessible to people with disabilities (e.g., missing image alt text, inaccessible forms, incompatible with screen readers). They cite a violation of Title III of the ADA. They make a demand for a cash settlement, often ranging from $2,500 to $25,000, alongside a request for accessibility fixes. The business/practice cuts a check in exchange for a release of any ADA claims by that plaintiff related to the website. The business/practice may then receive more demand letters, often from the same firm, on behalf of other plaintiffs who make the same claim, and the extortion continues. Don’t Act Impulsively – Do This Instead All this is not to say that dental practice owners should consider all such claims and demands to be frivolous or ignore their ADA obligations relating to their website. To be sure, a meritorious ADA lawsuit can indeed expose a practice to significant financial and reputational damage. Before reflexively giving in to an ADA demand letter and settling a supposed claim, practice owners should take the following steps: · Don't Panic, But Don't Ignore It. As noted, a demand letter with legalese and ominous language doesn’t mean that you’ve done anything wrong or actually violated the law. While your immediate reaction may include fear, confusion, or anger, don’t act impulsively. By the same token, don’t assume it is a bogus threat; crumble up the letter and throw it in the recycling. Deadlines in these letters are real, and failing to respond appropriately to a viable claim could lead to litigation. · Contact Your Attorney Immediately. This is not a DIY situation. Before responding to the letter or contacting the sender, consult with an attorney experienced in ADA compliance and website accessibility issues. Your lawyer can evaluate the demand letter or complaint, the validity of the claim, and the law firm behind it before formulating an appropriate response. Testers send many cookie-cutter letters that may contain boilerplate allegations of deficiencies that do not actually exist. · Evaluate Your Actual Compliance. Work with your attorney and website accessibility experts to have your website assessed against the Web Content Accessibility Guidelines (WCAG) , which courts often reference in ADA website cases. Understanding your site's actual accessibility helps inform whether settlement, remediation, or another approach makes sense and whether you need to take additional steps to avoid future claims. Keep in mind that this isn't just about legal compliance—it's good business. An accessible website serves all patients better and demonstrates your commitment to inclusivity. If you have questions about your business's ADA obligations and how to protect it from accessibility complaints, please call Grogan, Hesse & Uditsky at (630) 833-5533 or contact us online to arrange for your free initial consultation. At Grogan Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices. This blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
For employers and employees alike, in workplaces from restaurants to factories to dental practices, the specter of a visit from ICE, CBP, or other federal immigration forces looms large. Trepidation and fear are common feelings in this perilous climate, exacerbated by uncertainty as to one’s rights and how to respond when militarized agents arrive at a workplace. For dental practice owners, protecting their employees, patients, and business is a top priority, as is doing so in a legal, peaceful, and effective manner that doesn’t make a difficult situation worse. That is why it is so critical that you understand your rights and obligations in the face of such intrusions. While you should absolutely and immediately contact counsel if immigration agents show up at your practice, here is some practical guidance to help keep you and your employees safe. Different Responses to Different Types of ICE Actions Historically, ICE has conducted three types of workplace actions: I-9 audits (Notice of Inspection or “NOI”), which are administrative reviews of employment eligibility verification forms; worksite enforcement operations, which may include arrests; and searches pursuant to a warrant. Unfortunately, these customary practices have recently expanded to include warrantless, legally unauthorized, and sometimes violent entry into workplaces. The type of action the agency takes determines your obligations and your rights. An I-9 audit begins with a formal notice, typically giving you three business days to produce your I-9 forms and supporting documentation. A worksite enforcement operation or raid, however, often comes without warning. Understanding which situation you're facing is the critical first step. When ICE Arrives Without Notice – Keep Calm, Call Your Lawyer, and Ask For Authority If ICE agents appear at your workplace without prior notice, remain calm and follow these essential steps: · Keep calm , and don’t make any quick or impulsive decisions. Politely ask the agents to wait while you contact your attorney. You are not required to let agents enter non-public areas of your workplace without proper legal authority. While agents can enter your reception area or other common spaces as any member of the public could, they cannot access private areas such as treatment rooms, back offices, lunchrooms, or labs without your consent, a valid warrant, or an emergency. · Ask to see credentials and any warrants or legal documents. Scrutinize these thoroughly and understand this crucial distinction: an administrative warrant (Form I-200 or I-205) is not the same as a judicial warrant signed by a judge. Administrative warrants alone do not give ICE the authority to enter your private property or detain individuals. A judicial warrant, however, must be honored, though you should still speak with your lawyer who can help verify that it's properly signed, dated, and identifies the correct location and individuals. · Designate a single point of contact , ideally yourself as practice owner or an office manager, to communicate with the agents. Instruct other employees not to answer questions or provide information without guidance. This prevents confusion and minimizes the chances of miscommunication or escalation. Understanding Your Rights Employers have constitutional rights that apply during ICE encounters. The Fourth Amendment protects against unreasonable searches and seizures. As noted, without a judicial warrant or your consent, ICE generally cannot enter private areas of your practice, search filing cabinets or computer systems, or detain employees based solely on their immigration status. You have the right to refuse consent to a search. Exercise that right. If agents don't have a warrant, you can politely but firmly state: "I do not consent to a search of the premises. If you have a warrant signed by a judge, I would like to see it and have my attorney review it." If they have a warrant, verify it carefully to check that the address is correct, the signature is from a federal judge (not an ICE officer), and it's dated recently. Despite the recent rhetoric and actions of ICE agents and officials, you have an absolute right to observe, record, video, and document what's happening and what the agents are doing, so long as you do not interfere with or impede their operations. If ICE does enter your practice, you or your designated representative has the right to, and should, accompany agents to witness their actions. Protecting Your Employees Your employees also have rights, regardless of their immigration status. They have the right to remain silent and do not have to answer questions about their immigration status, where they were born, or how they entered the country. They have the right to refuse to show documents beyond what's necessary to demonstrate identity, unless they're under arrest. They should not lie or present false documents, as this can create additional legal problems. Before an ICE visit occurs, consider holding a "know your rights" training for employees. Inform them that if ICE arrives, they should remain calm, not run, and not present false documents. Provide them with a card that includes information about their rights and the contact information for your practice's attorney. You should never lie to federal agents or provide false information. However, you are not required to volunteer information or answer questions beyond what's legally necessary. If asked about specific employees, you can politely decline to answer and refer agents to your attorney. Once ICE agents leave, immediately document everything that occurred and save any videos or recordings so you can send them to your attorney. Preparing Before ICE Arrives The best time to prepare for an ICE visit is before it happens. Consider the following proactive steps: · Develop a written policy for your practice that designates who will handle ICE encounters, what steps to take, and how to contact your attorney. · Conduct an internal I-9 audit to identify and correct any paperwork errors or gaps. · Train office managers and supervisors on the protocol. Everyone should know not to consent to searches, not to answer questions without guidance, and to remain professional and calm. Post "know your rights" information for employees in common areas. If you have any questions or concerns regarding ICE or immigration enforcement activities at your practice, please contact Grogan, Hesse & Uditsky today. We focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
Selling a dental practice is a lengthy and involved process that involves due diligence, negotiation, drafting, financing, and other elements, culminating in the seller handing over the keys to the business to the buyer. But the parties’ signatures on the final purchase agreement and ancillary documents hardly mean that the now-former owner can ride off into the sunset without a care in the world. That is because the purchaser will want and require the seller to be responsible for any undisclosed or undiscovered problems with the practice they just bought. For this reason, every dental practice purchase agreement will inevitably contain indemnification provisions that address what happens if problems emerge after closing. These clauses determine who bears the risk for post-closing discoveries and how much exposure each party faces. While the purchaser wants the assurances and protections that come from the contract’s indemnification provisions, the seller doesn’t want to make an open-ended, potentially limitless promise that could eviscerate the financial upsides of the transaction and leave them forever on the hook for millions of dollars in possible liability. That is why deal savvy dental practice attorneys usually require that the purchase and sale agreement’s indemnification provisions include “caps” and “baskets” that establish the maximum exposure a seller will face as well as the minimum amount that must be at issue before any indemnification obligations are triggered. Given the significance that these maximums and minimums have for both parties, it is critical that buyers and sellers understand how caps and baskets work and the best ways to protect their respective interests in a dental practice sale. It All Starts With the Seller’s Representations and Warranties In any dental practice sale, the seller makes certain representations and warranties about the practice and its current condition. These disclosures might include assurances that all patient records are accurate, all equipment is in good working order, the practice has no pending lawsuits or liabilities, all taxes have been paid, and certain personnel matters are in order. If any such representations prove to be false, the indemnification provisions give the buyer the right to seek compensation from the seller for any losses incurred. Liability Caps Establish the Seller’s Maximum Indemnification Exposure A liability cap limits the total amount a seller must pay for breaches of representations and warranties. In dental practice transactions, caps can range from 10% on longer transactions to 100% of the purchase price on practices trending below $1,000,000, with 25% to 50% being most common for middle-market acquisitions. Where the parties ultimately land as to that percentage is a factor of each party’s risk tolerance and the practice's characteristics. A well-established practice with meticulous records, abundant goodwill, and comprehensive due diligence might justify a lower cap. Conversely, a practice with a limited or checkered financial history or significant operational complexity might warrant a higher cap to protect the buyer. Most liability caps exclude certain matters for which the seller remains on the hook for an unlimited amount. Such issues can include overt fraud or fundamental misrepresentations regarding the seller's authority to sell the practice or having clear title to assets. Tax obligations, environmental issues, and employee-related liabilities might also receive special treatment with separate, higher caps than provided for other matters. Baskets Are Like Deductibles While caps address maximum liability, baskets establish minimum thresholds before indemnification obligations arise. Think of a basket like a deductible in an insurance policy. Just as an insured is responsible for paying amounts up to the deductible before the insurer’s obligations kick in, a basket establishes the threshold below which the purchaser must bear any costs or liabilities for post-closing problems, even for matters covered by the contract’s indemnification provisions. Dental practice sales typically include one of two basket types: · A “true deductible” basket provides that the buyer absorbs all losses until reaching the threshold amount, after which they are entitled to recover all sums above it. For example, with a $25,000 true deductible basket, if the buyer’s losses total $30,000, the seller pays only $5,000. · A “tipping” basket , sometimes called a dollar-one basket, provides that once the buyer’s losses exceed the designated threshold, the seller pays from dollar one. Using the same example, the seller would pay the entire $30,000 once that threshold is crossed. Basket amounts in dental practice sales typically range from $5,000 to $25,000, depending on deal size. A $500,000 practice might have a $5,000 basket, while a $3 million practice might see a $25,000 threshold, for example. How Caps and Baskets Impact the Parties After Closing These provisions significantly impact post-closing dynamics. A seller who negotiates a low cap and high basket will minimize their exposure, while a buyer who secures a high cap and low basket gains significant protection and reassurance. Since negotiations over indemnification caps and baskets aren’t conducted in a vacuum, a party that secures an advantageous cap and basket arrangement can expect more challenging negotiations when discussing other aspects of the transaction, such as a higher purchase price or less favorable payment terms. Unanticipated liabilities can wreak havoc for dental practice buyers and sellers alike long after the ink has dried on their agreement. Dentists on either side of a practice sale should work closely with experienced legal counsel to negotiate terms that strike an appropriate balance between protection and practicality. Contact Grogan, Hesse & Uditsky Today If you are a practice owner anticipating a sale or transition, please contact Grogan, Hesse & Uditsky today. We focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
