Dr. Roy Shelburne was, by all accounts, living the dream. He was leading a successful dental practice. He was providing high-quality care to patients who otherwise would’ve gone without. And he was serving a community of friends and family.

In 2003, the FBI kicked down his door. Over the next few years, his every word was scrutinized. A few years later, he was indicted and found guilty of healthcare fraud, racketeering, money laundering, etc. He spent 19 months in a federal prison. He concedes his record keeping was faulty. Now he teaches others how to avoid fatal mistakes. We find his story compelling. And we believe the services he provides are critical to the practice of good medicine.

We are privileged to have him as our guest on this episode of the Medical Liability Minute. Listen below or click here to read the podcast transcript…

Episode Transcript

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Jeff Segal, MD, JD 

All right, welcome everyone. This is the Medical Liability Minute. And of course, it lasts for longer than a minute. My name is Jeff Segal and I’m the founder and CEO of Medical and Dental Justice. And we’re honored today to have as our guest, Dr. Roy Shelburne. We met on the phone several years ago and I found his narrative absolutely compelling. The tagline on his website has meaning on multiple levels and he’ll do a deep dive and explain to you precisely what I’m talking about. But it’s “a prisoner set free.” A prisoner set free. Dr. Shelburne spent time in prison. And I know he chose those words deliberately and carefully. So, he had a successful dental practice. I believe he was living the dream. Unlike most dentists, he took care of Medicaid patients, many of whom would otherwise have minimal access to quality dental care. Then he got sucked into a Kafkaesque experience that he was unprepared for. Fast forward and he was prosecuted for a record keeping snafu that cost him his freedom. He has since re-emerged and is on a mission. So, here’s a quote from his website.

“He’s seen how the smallest record keeping mistakes can spell doom for a practice and he wants to share the insights and wisdom he gained through his experience with the legal system”. In other words, how to prosper and avoid being surprised by an aggressive prosecutor and avoid going to prison.

So, here’s his background. He graduated with honors from Virginia Commonwealth University School of Dentistry, served as president of Southwestern Virginia Dental Society and even did a short-term missionary work in Honduras. In 2003, the FBI broke down the door to his office and confiscated records over the next three years. 

Everything he said and did was scrutinized. In 2006, he was indicted and in 2008 found guilty of healthcare fraud, racketeering, money laundering, etc. He spent 19 months in a federal prison in Kentucky before being released in 2010. He fully concedes that records billing systems and coding systems were faulty. Now he speaks and teaches others how to do it right. 

This is an amazing story and there’s a lot to unpack. Roy, thanks so much for joining us today. And please fill in the blanks on my summary of what you did and what happened to you. I know that’s more bullet points that can be filled in about 60 seconds – you’re on. 

Roy Shelburne, DDS 

Thanks for having me. I appreciate it. I guess most of the listeners have not heard a bio like that from speakers who you’ve had on before and certainly it would not be one that I sought to be able to convey – but it is what it is. I had a practice in a small town in the western part of Virginia for about 27 years. In fact, my practice was in my grandfather’s hardware store building. I’d gone away to college and then to dental school, came back to set-up my practice, opened in July of 1981, and was happy as a clam. I was born and raised there.  

 Unfortunately, the western part of Virginia (it was in the southern part of the Appalachian Mountains) is a very poor area, not a whole lot of industry. So, between 90 – 95% of the inhabitants under 18 years of age were covered under Medicaid. And you know, those were my neighbors, that was my family, and I felt it was important to provide care for the people that lived in my area. So, the practice was about 50% Medicaid, 50% otherwise, and I worked there happily for 27 years.  

I think I had actually flown to California to the American Dental Association meeting in 2003 and I was listening to Rudolph Giuliani speak when my phone began to vibrate during Giuliani’s speech and it was my wife who was calling and I waited for Giuliani to finish and I called her. She was not at home, either. She was visiting my daughter, who was at Virginia Tech at the time, and I called my wife to find out the FBI had come to my office, battered down the back door, and were taking all my records. I was sitting shocked in that auditorium in California as everybody else filed out. I was trying to figure out what I was going to do with the rest of my life. I was shocked. Obviously, the wind was knocked out of me. I was sitting there trying to figure out what I was going to do, and I called my office. It was Friday and the team wasn’t gonna be there, so I didn’t expect anybody to answer the phone. 

Jeff Segal, MD, JD 

Roy, just hang on a second. Did you have any hint that this was going to happen at all? I mean, you were happy as a clam – and then this happened. Was there any interim event, maybe like a light bulb going off, saying that something may be going on? 

Roy Shelburne, DDS 

No. 

Jeff Segal, MD, JD 

So, this was a shock.  

Roy Shelburne, DDS 

No warning whatsoever. You know, as far as any issues with Medicaid, I never had any. And in fact, this was never a Medicaid issue. Generally, if there is an issue with a provider, it’s addressed by the Virginia Medicaid or state Medicaid group. No, there was never an issue with Medicaid. And in fact, after I was indicted, Delta Dental (who is DentaQuest now and the administrator of Virginia Medicaid who processed claims and did reviews during the investigation after I was indicted) did an audit and the first audit was clean and the government came back and said, “No – you don’t understand. He’s done this, this, and this. He’s been indicted. We want you to do a more in-depth evaluation.”  

And they pulled the records from the 15 patients that I had done the most comprehensive work on. So, pulled from the software was the list of patients and they were organized from the greatest amount of reimbursement to least.  And the 15 patients we had done the most comprehensive work and been paid the most for, they pulled those the second time. And there was a more comprehensive audit done, I think there were three dentists or hygienists and some businesspeople to review that at DentaQuest. And it came back clean. They said they didn’t see anything wrong with my submissions, or what had gone on was not atypical. So, Medicaid had no issue whatsoever and the government came back and said, “Well – you just don’t have the expertise we have to go to the depths we’ve gone to determine he’s committing healthcare fraud”. So, fast forward after discovery – I was in California and I called my office. Like I said, it was Friday and I didn’t expect anybody to answer the phone – but somebody did. 

 The voice on the other end said, “Hello?” And I said, “Hello – who is this?” And they said, “Who’s this?” And I said, “I’m Dr. Shelburne. I own the office you’re in and the phone you’re talking on – can you tell me what’s going on?” He introduced himself as an FBI agent and that he had executed a search warrant and that I was a target of a healthcare fraud investigation. So, I flew home and I was able to get to my office. It was in the evening, it was 9 o’clock or so, but I drove past my office and it was surrounded by crime scene tape and there were multiple FBI vehicles surrounding my practice. 

Jeff Segal, MD, JD 

That was probably a long flight from the West Coast. 

Roy Shelburne, DDS 

And believe me, I was in shock. You know, it was all a big black hole. You know, I sat with my head down and I was just trying to figure out what the world was going on. My practice was in the biggest town in the county and that population was 1800 – a very small rural area. Everybody knew everybody else. And the search and seizure was the day before the county festival, so the next day there were parades through town, there were booths set up on the side of the streets, and our practice was the topic of conversation. We were investigated very deeply for the next three years. I was indicted three years and two days after the search and seizure. 

So, October of the year, I get kind of squirrelly – because that’s when it happened. I was prepared for trial for about a year and a half.  

Jeff Segal, MD, JD 

And you were still working in an active practice in between them seizing records and you being indicted and going to trial. Or is that a fallacy? 

Roy Shelburne, DDS 

No, no, no, that is a fact. That’s all true and in fact, the best year I ever had financially was the year after my indictment and before my prosecution. Now, interestingly enough, we as dentists, we diagnose treatment that we recommend for patients or whatever reason they don’t accept it for that year and a half they would come in and I would go there again, I would say, “You know, you really need to have this tooth crowned, there is an issue with it.” And they would literally be in my chair and they’d go, “I know, I know, and I want you to do it.” 

They would roll back in the chair and look at me and go, “I don’t know if you’re gonna be here or not – so go ahead and do it now.” 

Jeff Segal, MD, JD 

I know a surgeon that had a drug charge. He was going to surrender and go to a federal prison sometime in October of that year. So, there was a window of time when he was still out there, and he still had a license to practice. And interestingly, he’d have people calling and say, “Doc, I know you have a commitment at the end of the year.” And they used a euphemism, some type of commitment at the end of the year. And they’d go on and say, “Is there any way you can squeeze me in sooner?” 

The point being is that they trusted him. Nothing changed in the level of trust, and you then start to realize the impact it has on the surrounding community, and not just the doctor himself, but also the people who work at the practice, the patients who come to see the dentist, etc. So, I mean, you realize what a giant web this creates. And if you were trusted before, you know, most of the people probably still trusted you after. Anyway, keep going – I did not mean to interrupt. 

Roy Shelburne, DDS 

No, it’s a segue into that, actually. My son graduated from dental school in May, when I surrendered my license. I went to prison in July and then August. So, he had not intended to come back to the practice, but because when I was arrested, I was charged with racketeering and money laundering, which allowed the government to confiscate everything we owned at that point. So, I could not continue to support my children in their university life. So, he signed an agreement with the state of Virginia agreeing to provide care to the indigent in exchange for tuition reimbursement. 

So, he came to my practice and he is there even today. His only complaint has ever been that he’s too busy. He’s an amazing dentist. 

Jeff Segal, MD, JD 

 Well, that’s positive. And it sounded like that might not have been in the cards, otherwise. 

Roy Shelburne, DDS 

The practice would have closed otherwise. You know, we tried to market it, tried to sell it beforehand, and of course, it’s tainted and nobody wanted it. 

So, for all intents and purposes, it was worthless. And the people in the area would have gone untreated during that period because there would be nobody in the area willing or able to be able to take care of them. So, the interesting thing was, I went to trial a year and a half afterward. It was a nine-day trial and I thought there were 118 instances the government brought that could be construed as healthcare fraud and one charge of healthcare fraud. So, they had 118 attempts to find me guilty. I was charged with racketeering and money laundering as well because I was charged with racketeering and money laundering when I was arrested. 

The government confiscated everything we owned. So, they came with eight officers. They came with three flatbed car haulers. They pulled the vehicles out of the garages and put them on flat beds and took them away. At the same time I was being arrested, they went to my three children’s universities. They confiscated their vehicles as well. They confiscated the contents of our bank accounts, so we had no money whatsoever. My wife’s vehicle was in her name, my children’s vehicles were in their names, but because I was charged with money laundering, if you get an asset that you’re not entitled to and it goes into a legitimate account (like a business account for my office) and I use that account to pay for anything or to make a payment for my children’s vehicles, those assets are subject to confiscation. So, they took everything we owned. Try putting together a defense, try hiring an attorney, and try hiring expert witnesses when you own nothing. It’s a little daunting to put together a defense during the trial. 

Jeff Segal, MD, JD 

So, there was no money left over to hire or pay for an attorney? Is that accurate? Meaning that with the civil forfeiture – it seems like your right to an attorney should be sacred, but what you’re saying is you can still get an attorney. It’s just now you’re indigent and you must take what you’re given. Is that right? 

Roy Shelburne, DDS 

It would be assigned to you as a public defender.  

Jeff Segal, MD, JD 

Right.  

Roy Shelburne, DDS 

You do have a right to one, but you get what you pay for, I guess. 

Jeff Segal, MD, JD 

 You have a right to an attorney, but not any attorney. 

Roy Shelburne, DDS 

Correct. Not of your choice, it’s assigned. So, like I said, try putting all that together and try getting ready for the trial. And you know, the interesting thing is the jury – I thought would be all about the allegations – the 118 allegations of healthcare fraud. But the first three and a half days were all about our home and our vacations. And it made it look like I was all about the money. And the jury is never aware of the amount that is involved. And to be honest with you, as I said, I operated a bit busy Medicaid practice, so they did an evaluation over the course of six years, because the statute of limitations will allow you to go back six years. And during the six years I was paid about $3.5 million for the work that I provided for the Medicaid patients. And of the $3.5 million – the jury is never made aware of the amount. So, who knows how much they thought I got that I wasn’t entitled to of the $3.5 million? But the prosecutors during sentencing established the amount.  

 And the amount that they established that we got of the $3.5 million that I was not entitled to was $17,899.57. 

Jeff Segal, MD, JD 

Repeat that again. 

Roy Shelburne, DDS 

Of that $3.5 million, the government determined the amount of money I received that I was not entitled to was $17,899.57. And even though we were able to go back through that six year period of time and review and find treatment that we had provided, should have billed for, and could have billed for, and had been paid for in excess of that $17,000 amount, it made no difference. 

Jeff Segal, MD, JD 

Meaning, if you had bullet-proof record keeping from start to finish, the government – or Medicaid, rather – would have owed you money. 

Roy Shelburne, DDS 

Owed me money, yes. And they withheld for six months [funds] for treatment that I had provided in excess of that amount. 

Jeff Segal, MD, JD 

This is a shocking story. So, they conceded that at trial, correct? You said that at trial, they were bitching and moaning about $17,000 with a denominator of $3.5 million. They conceded that – is that accurate? 

Roy Shelburne, DDS 

They established that – it’s one of those things. For the government to establish the amount that I got that I wasn’t entitled to before the judge to determine the amount that I got. We didn’t refute it. We didn’t say anything, but the number was probably accurate. We didn’t refute that at all. It was their responsibility to determine that amount. And that’s the amount that they determined. 

Jeff Segal, MD, JD 

Well, these were men and women on a mission. 

Roy Shelburne, DDS 

Seems so.  

Jeff Segal, MD, JD 

You know, it’s interesting. So, I eyeballed the expert that testified on your behalf. I believe her name is Dr. Susan Phillips, who is an insurance consultant with a claims review organization. A 20-year veteran. 

Roy Shelburne, DDS 

She works for insurance [carriers]. She is a professional who reviews claims for insurance companies to determine whether they should be appropriately paid or not. Yeah. Yeah. She was an expert for me. 

Jeff Segal, MD, JD 

Well, I’m looking at the quote that she supplied to the press: “I saw no pattern or scheme to defraud. And I’m very familiar with what to look for because reviewing claims and records for fraudulent or suspicious submissions is a routine part of my job.” That’s what she’s stating. I mean, I would have thought with this support you must have felt pretty good about your chances at trial. 

Roy Shelburne, DDS 

Well, in fact, during sentencing the judge determines the amount of time you’re going to spend and the restitution that you pay. And going into sentencing, the pre-sentencing report establishes the amount of time (maximum to minimum) that you can expect to be sentenced. Going into sentencing, the minimum amount of time I would have spent was 15 years. 

Jeff Segal, MD, JD 

15 years? 

Roy Shelburne, DDS 

15 years – because I was found guilty of healthcare fraud, racketeering, and money laundering. When you add all those up, the minimum amount of time I would have spent from the pre-sentencing report was 15 years. Six days before I was to be sentenced – six days – the Supreme Court ruled they defined a single word in the money laundering statutes – just one word. This word had gone through the system to get to the Supreme Court for their determination, I think about six and a half years. So, it took six and a half years for the Supreme Court to review and to determine the definition of this word. They arrived at their conclusion six days before I was to be sentenced, and my attorney read the determination and he said, “I think the way they define that word, it makes it so it doesn’t apply in your case”.  

So, there was one charge of healthcare fraud, one charge of racketeering, and five charges of money laundering. So, if you get money you’re not entitled and it goes into a legitimate business account, any way you distribute the money is a different charge of money laundering. So, if you write a check, that’s one way. If you pay by credit card, that’s another way. If you pay by cash, that’s another way. So, any way money is distributed, it’s a different count. So, there were five counts of money laundering, which was a major component. Six days before I was to be sentenced, the Supreme Court ruled on this word. And my attorney wrote a letter of motion to the judge asking the judge to set aside the money laundering convictions based on the Supreme Court decision that occurred six days before I was to be sentenced. Going into sentencing, the best I could hope for was 15 years. 

And the judge started by saying that he was going to deviate from the mandatory. Well, first he set aside the money laundering statutes based on the Supreme Court decision. He agreed with my attorney’s argument. So, that took the five money laundering charges off. Which reduced the sentencing guidelines to 47 months, which is much better than 15 years. And the judge sentenced me to 24. He deviated below and the law indicates that the judge can only do that if there is a significant reason for doing that. 

And I have a quote from the transcripts from that sentencing, which the judge basically said he thought the verdict could have gone either way. He wasn’t going to set aside the jury’s verdict, but he would adjust the time spent. 

So, he went from the 47 months to 24 months. 

Jeff Segal, MD, JD 

Boy, your luck had turned, had it not? 

Roy Shelburne, DDS 

Well, you know, there were providential things that happened through the whole process.

When I was being arrested, it was before the judge. And my attorney and the prosecutor, prior to, had come to an agreement regarding the terms of bail. And one of the stipulations the prosecutor made was that I wouldn’t be able to practice dentistry. So, the judge, you know – he came in and we all stood. Then we sat down and he looked at the prosecutor and asked about the charges. The prosecutor outlined the charges and then he asked about the terms of bail. The prosecutor outlined the terms of bail and typically what would have happened, he would have looked at me and my attorney and said, “Are there any objections?”  

And because that was the agreement that had been made prior to, we would have said, “No”, the gavel would have hit, and my license would have been immediately confiscated.  But the judge – rather than doing that – turned to the prosecutor. And the prosecutor said, “We’ve asked for Dr. Shelburne to surrender his license to practice.”  

The judge looked at the prosecutor and said, “Sir, does the Board of Dentistry of Virginia still exist?”  

 And the prosecutor said, “Yes.” 

And the judge looked at the prosecutor and said,” So, you’re asking me to supersede the power of another governmental agency who has been given the responsibility to determine whether or not individuals can practice in the state of Virginia? You’re asking me to supersede that governmental agency?”  

 And the prosecutor looked at the judge and said, “I guess?”  

And the judge said,” I’m not going to do that until the Board acts on this man’s license. He can practice dentistry.” 

Jeff Segal, MD, JD 

Perfect.  

Roy Shelburne, DDS 

So, I was able to go back, and like I said I continued to practice during that preparation time for the trial. 

Jeff Segal, MD, JD 

Now, you also said that the area had a large demographic of Medicaid patients. Were you still able to see the indigent? To see Medicaid patients in that window of time? Or is that something that you were unable to do? 

Roy Shelburne, DDS 

Yes, I was – until the day I surrendered my license. Like I said, Medicaid had done the audits and they didn’t have an issue, so the government had encouraged Medicaid to do more audits. They thought that they would find issues and that they would suspend my ability to provide service to Medicaid patients. And they did the review and they indicated that they didn’t have any issues. So, I was literally able to see Medicaid patients until the day I surrendered my license. 

Jeff Segal, MD, JD 

So, to the extent there were any billing issues, were they related to non-Medicaid patients? 

Roy Shelburne, DDS 

It was government reimbursement. For example, there were 118 issues and one of them was a billing issue. In 2005, there were two separate codes to be used for simple extractions of teeth. There was one code for the first extraction. There was a different code for additional extractions, and there was a process of reimbursement differential about $2.64. So, rather than using the code for the first extraction and then using a correct code for the second and third extractions, we used the primary code for both first, second, and third, which resulted in payments of $2.64 more for the second and third.

So, did we get money that we weren’t entitled to? Yes, we did. Should we have had ability to be able to identify and correct that and send that back? Yes. You know, from a legal standpoint, the definition of intent to defraud is much different than I had believed. I thought you intended to defraud if you sent a claim for a patient you never saw or a service you never provided. Certainly, that would be intent to defraud. But the legal definition is much broader. Which includes what’s considered blind disregard. Which means – if you do the same thing the same way without having systems to identify and correct your errors, that is from a legal standpoint considered intent to defraud. I didn’t understand that. I thought a simple mistake was a simple mistake. I always thought that if I got something I wasn’t entitled to, I could send it back with any interest or penalties. The best offer I ever got to settle prior to going to trial was three years in prison and a restitution $300,000. 

Jeff Segal, MD, JD 

You know, that conclusion would come as a shock to most people listening to this podcast. I think most people believe billing works like this – you send in codes, you get paid, and that you do your best. You try to make sure it’s reasonably accurate and hopefully the documentation supports it. But I’m positive that if you have 100 people listening to this podcast right now, and if they’re doing coding and billing, there’s not a single person out there that will have a pristine record. I’m positive of that. 

Roy Shelburne, DDS 

We sent records to about 15 different practitioners in the area trying to identify expert testimony on my behalf. Every single one of them came back and said, “There’s not a thing you’ve done that hasn’t happened in our practice.” And something that’s kind of shocking as well: I lecture a lot, so I’m around the country and I generally ask, “How many of you have a seven-step compliance program in your practice?” And people’s eyes glaze over. I do several speeches a year and I have had two individuals who raise their hand and affirmed that they have the program. I asked both about the circumstances that led them to adopt those programs, and both said they were audited and found out that they needed those programs.  

There’s a mandated seven step compliance program that you must adopt if you accept government payment of any kind. If you do not adopt it, the argument can be made that you are in a state of blind disregard because you didn’t have a system to identify and correct those errors. 

Jeff Segal, MD, JD 

You know, participating in almost any government program, they’re all sorts of requirements that most doctors aren’t aware of. Just to give one example – to be compliant with HIPAA, you need to have a notice of privacy practices and you need to have the proper authorizations in place. But what I think most people are unaware of is that you need to do a formal risk assessment. One where you look at everything – your procedures, your training methods, your computer systems, etc. 

This is a very deep and involved process. And if you get hit with a HIPAA breach or a HIPAA audit, and you don’t have that documentation up front, you will burn. But what’s fascinating is that when the Office of Inspector General (the Department of Health and Human Services) did a general audit to see how many people were fully compliant with the dictates of HIPAA, it was in single digits. Meaning that less than 10% were fully compliant. I mean, these are good people, they’re good doctors – they just don’t know. 

Roy Shelburne, DDS 

You’re preaching my message. What you do not know will come back to bite you. 

Jeff Segal, MD, JD 

Right.  

Roy Shelburne, DDS 

Ignorance is no excuse. That’s what I tell people. You know, people say, “Well, that’s never going to happen to me.” Well, I’m that guy. You know, those were my words. 

Jeff Segal, MD, JD 

This is a phrase I first heard from a plaintiff attorney when he was describing medical malpractice cases. He said, and I know we’ve all heard it before: “If it wasn’t documented, it wasn’t done.” And this is a phrase that sets doctors on fire. Particularly physicians. They argue in response that they have time to take care of the patient, or that they have time to document. Pick one. And you know, having lived through what you lived through, I think that you would argue that it is not a choice. You must do both. You can’t just do one.  

Roy Shelburne, DDS 

It’s key. It is key.  And I’ll expand on what you said. If it’s not in your clinical record, it was not seen, it was not said, it did not need to be done, it wasn’t done, it does not exist from a legal perspective. There’s no way you can defend yourself verbally without having made a notation in that clinical record, because otherwise you’re just covering your behind after the fact.  

Jeff Segal, MD, JD 

Right.  

Roy Shelburne, DDS 

That is a legal document that will speak loudly and strongly on your behalf. It will literally testify for you if you capture the information that’s necessary. 

If you leave anything to the imagination, people can take it anywhere they want to take it. And to your point about malpractice – what’s the first thing that’s going to happen if a patient makes a complaint to an attorney? What are they going to ask for?  They’re gonna ask for the clinical record. 

Jeff Segal, MD, JD 

Yes.  

Roy Shelburne, DDS 

And if it establishes what was done, why it was done, and provides a step by step process from the doctor’s point of view, that attorney will not move forward with that case. Because that’s a hard one to make.  

Jeff Segal, MD, JD 

Right.  

Roy Shelburne, DDS 

They don’t want to have to work that hard. To refute that clinical record by a patient’s testimony, that’s going to be very difficult thing to do. However, if there is anything left to the imagination in that clinical record, that can very readily be a case moving forward. 

Jeff Segal, MD, JD 

This is an amazing narrative. Ultimately, this came down to records, correct? 

Roy Shelburne, DDS 

Well, establishing medical necessity in the clinical record? Absolutely. And then billing issues accurately and using the correct billing codes to get reimbursement. So, it was a two-edged sword. Documentation to establish medical necessity, the need for the treatment, and then the billing that corresponds appropriately to the treatments you provided. So, both the billing, as well as the documentation.  

Jeff Segal, MD, JD 

So, the documentation and the billing go hand in hand.  

Roy Shelburne, DDS 

One must support the other. 

Jeff Segal, MD, JD 

So, you make it to trial. And the jury came back. Did you have an idea how this would go? I mean, I’m sure you’re hoping against hope this would work out in your favor. You didn’t plead it. You ultimately went to the jury?  

Roy Shelburne, DDS 

It went to the jury. Both sides had testimony, but also presented a significant amount of supportive information. The jury went to a room and asked for nothing. None of the evidence. They sat in the room and talked for about two days.  

Jeff Segal, MD, JD 

Right.  

Roy Shelburne, DDS 

And they asked for nothing, as far as supported documentation. And two hours before they came back with a verdict, they had a question for the judge. And they shared that question with both the prosecution and with my defense team. And the question was, “If we find him guilty of racketeering and money laundering, do we have to find him guilty of healthcare fraud?” 

Which was backwards. You must have committed healthcare fraud before you could have committed racketeering and money laundering. So, it appeared that they had decided I was guilty of racketeering and money laundering, but they hadn’t decided whether I was guilty of healthcare fraud. Which, like I said, you can’t have done one without doing the other.  

Jeff Segal, MD, JD 

Right.  

Roy Shelburne, DDS 

So, that gave us a good idea that, yeah – it was gonna be all negative. And to be honest with you, it had to be a jury trial and they had expert witnesses that testified. For example, we did several pulpotomies and stainless-steel crowns on primary teeth. They had an expert witness that testified if a baby tooth were decayed to any great extent, it should be extracted. It shouldn’t be restored. And my position is: That child needs teeth to chew with, and those teeth hold space for the permanent teeth. So, it’s important that you maintain them. Their expert was a dentist who said that if the tooth is a baby tooth and was decayed, it needed to be extracted. And you know, for example, you have a mother who’s on the jury who is working. She can’t afford dental insurance for the child. But they pay taxes, and their tax money is paying this doctor to provide unnecessary treatment – pulpotomies and the stainless-steel crowns on these primary teeth.  

And they can’t even afford to take the children to the dentist even have basic treatment done. And by the way, if they have a child with a baby tooth, they’re certainly not going to get it filled. They can’t afford it. They’re going to wait to have it extracted. So, you know, I was giving comprehensive care, using their tax money, with an expert witness (a dentist) who said the tooth shouldn’t be filled. It should be pulled – it’s a baby tooth. 

So, it’s an uphill climb. You know, convincing a patient who has an expert witness that testifies to one thing and our expert testifies to another, so it’s up for them to decide what’s right and what’s wrong and they have preconceived notions as individuals about the need for care. So, like I said, it’s kind of an uphill battle. 

And if you spend the first two days talking about the dentist’s lavish lifestyle, his vacations, his house, etc. They kind of set the stage prior to – and by the way, you know, we get paid all this money for doing all this work. And by the way, our expert says it wasn’t even necessary. 

So, my documentation should have been better at supporting the medical necessity for those stainless-steel crowns, and why we did them. And like I said, should that have been the case, I think it would have changed the outcome. Although, you know, it’s one of those things I look back on and think: It’s woulda, coulda, shoulda. 

Jeff Segal, MD, JD 

You were in a community of less than 2,000 people. Where was the federal trial held? How far was it from the community you lived? And were there – I mean, it sounds like it was sparsely populated. Highly possible or probable that the jury pool consisted of people that you took care – or their kids. 

Roy Shelburne, DDS 

No, there were 50 in the jury pool. They moved it from Big Stone Gap, which was a community closest to Abingdon, VA, and isolated it. They started out with a jury pool of 50. And on the day before the trial, they bring all those 50 jurors and the judge asks, “Does anybody know Dr. Shelburne or the prosecutor?”  

And they (the jurors) raised their hand, and the judge would ask them questions, and if the judge felt like the relationship was close enough that they couldn’t be impartial, he dismissed them. So, that automatically changed the 50 to 35. So, of the 35, there was a hygienist and a chairside assistant within that group. And the way we went from 35 down to 12 is like this – the prosecution eliminated one. And then my team eliminated one. And then prosecutor eliminated another, and then we eliminated another, and the prosecution eliminated the hygienist and the chairside assistant, number one and number two. 

So, they want nobody on the jury that knows anything about dentistry. It’ll be the same thing with medicine – they don’t want nurses or doctors, anybody who has any idea about the ins and outs of what we do.  

Jeff Segal, MD, JD 

Right. Even after going through this ordeal, you’re one of the most upbeat people I know. So, how did you survive the ordeal of prison? What is life like inside a federal prison? What did you learn? How did it change you? 

Roy Shelburne, DDS 

I was in a prison camp, which is certainly not a country club. Generally, they will put you in a facility that is as close to your home as possible, and there’s a facility that’s about four miles from my home. The problem is there were people who worked at the prison who were patients of mine, and they figured that would probably not be a good idea – I might get preferential treatment if I treated them well, or I may have been treated badly if I treated them badly. So, they put me in a facility about 2.5 hours away from home. 

There were no walls, no doors, no bars. You could literally walk away – but if you did try to escape, you would go to a facility that had walls and doors. There were there were no violent offenders, there were no sexual offenders. We provided care and support for either the inmates in the camp or we maintained the medium security facility that was next door. We washed windows, we cleaned floors, we did whatever was necessary to maintain the place. I didn’t feel threatened, I didn’t feel scared. 

But it was boring. I started out sweeping floors. And then I was promoted to washing windows. I ended up maintaining the library. And you know, I was isolated. I was from outside of the community. The demographics were 15% white collar, maybe 85% nonviolent drug offenders. And I spent 19 months there, two months in a halfway house, and it was much harder for my family. They were in the public. They knew the judgement of the people around them. People said things, and it was ugly for them. It was much harder for them than it was for me. And that part, you know, is most disconcerting. It breaks my heart. 

Jeff Segal, MD, JD 

Well, I’m sure they must have visited you on a regular basis. And were they telling you how the community was treating them? Or did they keep that from you, you know, to make it less painful for you? Was this something that they just bore on their own? 

Roy Shelburne, DDS 

Yeah. In fact, my wife worked a short time for me when I first opened the practice, and she became my son’s office manager. And she spent every day in the office and occasionally patients would say something that would be hurtful, and they may not have known she was my wife. And she was very gracious in the process. I have an amazing family. They’ve been loving and supportive, and I can’t say enough about their love and their support, which has made it possible for me to do what I’ve been able to do.  

It was miracle I was able to get my license back. I surrendered it voluntarily, prior to going to prison. Understanding that it was inevitable, that that was going to happen, and I did it prior to being incarcerated because it takes the whole Board to act on a revocation. And they would not meet until after I was released from prison. And the mandatory period of revocation, the minimal amount was three years. So, if I waited until after I was released from prison, it would have been three years from that point. 

So, I voluntarily surrendered it prior to going to prison. So, it started that clock ticking before I went in. So, I was able to re-apply for my license in July 2011. I’ve been online to find out if anybody had gotten their license back again from a revocation – and nobody ever had. So, I didn’t have a whole lot of hope that I would get my license back. But I’d done about almost 300 hours of CE (continuing education)  – mandatory amount is 15 hrs per year – so I needed 45, but I had about 300 hours of CE. I went to VCU, to the dental school, and spent 61 hours rotating through the different departments so they could observe my knowledge and my ability to be able to provide care, to provide a letter to the board, encouraging them to reinstate my license. 

I took my boards over again after 31 years. 

Jeff Segal, MD, JD 

I can’t even imagine that. 

Roy Shelburne, DDS 

I passed them a second time – actually, they were easier the second time. 

You have a lot of experience, so it’s kind of like riding a bike. The board met on December the 1st of 2011 to act on my request for a reinstatement and they gave my license back. And in fact, the Dental Association, the American Dental Association, I got my renewal for my dues while I was in prison. You get those in November. And I got the letter asking for the renewal, and I sent a letter back to the association in Virginia and I said, “Do you understand where I am? I can’t afford it, so I’m going to have to let my membership lapse.” 

I got a letter back from the director, Terry Dickinson at the time, and the letter said, “If and until you can pay for your dues, we’ll comp those.” So, I remained an American Dental Association member, even while I was in prison, and while my license was revoked. Because I had a lot of support from organized dentistry.  

Jeff Segal, MD, JD 

Did they send the journals to you in prison? That would have been one way of relieving the boredom. And the reason I bring up the issue of boredom is that I went to visit someone in a federal prison. It was a minimum-security prison, and you know, he said that the worst aspect of it, of course, other than losing your freedom, is the absolute and total boredom. Meaning that, you know, we’re used to being high charging, active people, and it just gets flipped on its head. I mean, it is the ultimate torture for someone who is a Type-A, obsessive compulsive individual, now with nothing but time on their hands. 

Roy Shelburne, DDS 

Yeah. So, I taught some classes. Spin classes on bikes and aerobics and I did whatever I could to stay busy.  

Jeff Segal, MD, JD 

You probably were in good shape, I would imagine, spending so much time on a spin bike.  

Roy Shelburne, DDS 

Yeah, there was nothing else really to do. 

Jeff Segal, MD, JD 

He looked the same way. I mean, when I went to visit him, I couldn’t believe what excellent shape he was in. And he said, “Well, you get a Type-A individual with nothing else to do.” I think it’s a reflection of the type of personality that, you know, just goes into the medical and dental world. 

Roy Shelburne, DDS 

I agree. You know, we’re all driven, we have goals and we have things that we want to accomplish. And if you take the primary out of the way you, find something else focus on. 

Jeff Segal, MD, JD 

So, what advice would you give for someone about to surrender and start a prison sentence in a federal penitentiary? Let’s assume it’s the same type of camp that you were in – something you have personal experience with. 

Roy Shelburne, DDS 

At some point, you must come to grips with it and forgive yourself. What happened has happened. You know, I have a quote that I like: “A bend in the road is only the end of the road if you fail to make the turn.” And does it take some time to get over it? It absolutely does. But you must forgive yourself and you also have to forgive everybody that’s associated with it. Otherwise, it makes you miserable and angry. And the only person that helps is nobody. 

Jeff Segal, MD, JD 

I mean, you would think it would be easy to be a victim or feel like a victim. But you’ve done a little bit different. I mean, I get the impression you took ownership of it and then flipped it on its head. I mean, you now actually go out and talk about this. It’s almost a cottage industry that you’ve created, delivering a very potent message to people: “Don’t do what I did. Let me show you how to do it. And while you may think you’re different, you are like me and I’m like you. It’s just that I now I have a message to deliver.” 

Roy Shelburne, DDS 

I am passionate about sharing the story. Not because I’m proud of it, but because I think people can benefit from my experience. 

Jeff Segal, MD, JD 

I mean, that’s how I met you initially. You’re a very charismatic individual, you have a very upbeat personality. And then I hear your story and I’m trying to make the connection. I’ve got a little bit of cognitive dissonance. It’s hard for me to make the connection between what you went through and what you’re doing now. You’ve turned a negative into a positive. And I know you spend a lot of time speaking to people. I’m sure some people call you when they’re in the middle of the crosshairs. And probably people call you when they’re just worried. What is that like? Because I know you give advice. You teach, you educate. Talk a bit about that. 

Roy Shelburne, DDS 

I spend a lot of time educating as far as lecturing and seminars. And webinars like these. You know, ignorance is scary. I want to be the last healthcare professional that goes to prison because he’s stupid.  

For example, I got an email last week from a young man who was being audited by an insurance company. And he wants to know: What’s the process like? What do they need to do?  

And of course, I’m not an attorney. I need to advise them first that I’m not an attorney. But I will address issues based on my understanding. And to be honest with you, a lot of times, especially if there’s an action against a dentist, you know, they’ll reach out to me and start spilling information – and I must stop them and say, “Do you understand? You’ve contacted me. And if it’s not through an attorney, anything you tell me is discoverable.” 

And so, you know, people just don’t know what they don’t know. Things as simple as, you know, you don’t say anything to anybody if you have an attorney. That’s attorney-client privilege. Anything you share with anybody otherwise, prior to, can be used against you.  

It’s just a matter of helping people through the process. I’m not the attorney, but I can give them an idea of what the process is like, and to be honest with you, the government entities, they have a cookie cutter way of putting together the process. And it’s kind of interesting. They have a Stage 1, Stage 2, Stage 3, etc. And it’s stage by stage, the way they work. Because that’s the way it has been established. 

Jeff Segal, MD, JD 

Your mantra seems to be: “Take ownership of what happened.” And America is the land of second chances. We are very forgiving people. Has that been your experience? Or are we a forgiving people often, but not entirely? 

Roy Shelburne, DDS 

You know, I learned early on never to prejudge anybody and their ability to understand. For example, I was at a hotel in Washington and I struck up a conversation with a lady in the lobby. She asked me why I was at the hotel. I said, “I’m here for a meeting.”  

And I asked her what she was there for, and she told me that she was at the hotel for a meeting, too. And she asked, “Well, what kind of meeting are you here for?” I told her I was there for dental classes and she goes to ask what classes I’m taking, and I said, “Well, actually, I’m teaching one.” 

 And she said, “Well, that’s interesting. And where’s your practice?”  

 And I said, “Well, I actually I don’t practice anymore. I speak and consult full-time. I retired from practicing.”  

 And she looked at me and she said, “Well, you’re young to retire.”  

 And I said, “Well, what are you here for?”  

 And she said, “I’m a federal judge from Texas.” And then she goes, “Well, how is it that you don’t practice anymore?”  

 And I said, “Well, to be honest with you, I am a convicted felon. I was convicted of healthcare fraud, racketeering, and money laundering, and I lecture trying to prevent the same from happening to my colleagues.” And I expected her to turn and run with her hair on fire in the other direction. But she didn’t.  

She leaned in and she said, “Really? Can you tell me a little bit more about that?”  

 I said, “Sure. What would you like to know?”  

Come to find out, she said that she’d sentence people frequently, and she never knew what that was about. So, we had a 45-minute conversation about the experience. I had prejudged her. I had prejudged a lot of people. And you know, of course, some of them are going to go dark. But I’ve come to realize that people have an affinity and a desire and a curiosity to learn more about it. 

Not everybody’s judgmental. Now, there are people that are, of course, but I prefer to give everybody a clean slate to begin with and to understand that people are fundamentally good. 

Jeff Segal, MD, JD 

Yeah. So, the one individual that I referenced earlier was a spine surgeon who spent time at a minimum-security prison in Alabama. I mean, his main thought was, “I do not want this to be the last act in my career.” He was thinking that this is a snapshot of his life. And by the way, it was a drug charge. So, it had nothing to do with patient care. He was in there for three years, came back, and he said he wanted his license back. And he was a talented surgeon. And he felt like he had a lot more to give. And ultimately, he did get his license back. He had a very good attorney. This took place in Florida, where he had been working previously, and Florida is not an easy state to get your license back if it’s either revoked or surrendered, etc. But he was able to do it – and he got hired. You know, he told me that it’s not just a matter of getting your license back. You’ve got to get hired. 

You’ve got to get people to trust you if you’re going to hang out a shingle. And of course, if you have competitors, everybody is going to point the finger and say, “Don’t go to him, go to me – because of X, Y, and Z.” But it was very cathartic for him, I think, to get back into the rhythm of life. And I think he struggled with it for a period, like many people do. But he felt as though he’d done his time and still had a lot to give. And he wouldn’t have chosen that path, but he said having gone through the path, he did not want that to be the end of the road – as you described. 

Roy Shelburne, DDS 

Correct. What happened to me is not who I am. It’s something that happened to me. And I think that’s something important for most people to realize – what has happened to you is not who you are. Bends in the road shape who you are, but in no way do they establish who you are, your expectations, or your limitations. 

Jeff Segal, MD, JD 

There’s an interesting analog for medical malpractice where, you know, if you’re in the middle of a malpractice case, it’s a snapshot. It’s not a movie for most people. Most physicians and surgeons, when you practice for an entire career, you will make a mistake. You’ll make a mistake that can be construed as being negligent. And when you’re in the crosshairs, you’ll be painted out to be a horrible ogre. A horrible human being. And it’s demoralizing, it’s depressing. It’s the type of thing that carries with it a lot of shame. 

And one thing we try to do is remind people that it’s one event in a lifetime. You know, a full career. I mean, if this happens all the time, that’s a different story. But for most people who have made a mistake, it’s not a pattern. It’s a single event, or a couple of events, and it’s a mistake to conclude that one mistake is indicative your entire life’s work. But you know, when you’re in the middle of the legal system, it’s something that’s easy to forget. 

Roy Shelburne, DDS 

When people are pointing at you and pointing out every possible negative thing that could be construed, whether it be true or not, you become defensive. For example, you mentioned in the introduction that I volunteered as a missionary in Honduras. And I did. And during any trial, one tries to establish oneself as a decent human being. So, we brought my volunteer work out at my trail.  

 I met with the group that went to Honduras in New Orleans. I spent a night there, both coming and going, so that I could make the early flight and meet my group and depart from New Orleans to Tegucigalpa – which is in Honduras. And when it became the prosecution’s turn to refute, or to come against everything we said, and they flashed a picture of the hotel that I stayed at in New Orleans, which was the W Hotel, and I’m a cheap guy – so I did it Priceline.  

And I may have paid $98 for the hotel. But anyway, they flashed a copy of that and thought about the hotel and the prosecutor looked at me and said, “Is this the hotel that you stayed in?”  

I said, “Yes.”  

And the prosecutor said, “Did you deduct the trip?”  

I responded, “Yes.”  

And the prosecutor responded, “You make it look like you’re a humanitarian, but look at this lavish hotel you stayed at, deducted as a donation, and you want people to believe that you are all about giving back?” 

Jeff Segal, MD, JD 

It’s a no-win situation. And by the way, I’ve stayed at the W before, and I wouldn’t say they’re all lavish hotels – at least that would be my experience. I remember one time I stayed there, the walls were paper thin – and it was about 1:00AM and I heard a fair amount of commotion on the other side. It seemed like they were having a wonderful time, actually – but I couldn’t get any shut eye. 

Roy Shelburne, DDS 

People can twist anything to make it look like anything they want – and ultimately, that’s the scary part.  You can spin anything the way you want, it’s just a matter of knowing who you are and why you do things. 

But you know, I knew why I did it. I knew my heart. I knew why I was providing care to those young people – because they needed it and they deserved it. Not because of any other reason. 

Jeff Segal, MD, JD 

It just seems irrelevant that you stayed at a hotel prior to doing missionary work. It just seems insane.  

Listen, we’re running short on time. And we’re going to close shortly. You’ve got a strong message to give. Why do you think some doctors ignore the message? Why wouldn’t they want to act before there is a problem? 

Roy Shelburne, DDS 

Because they bury their head in the sand and say, “It couldn’t happen to me.” You know, why would anybody care about what I did? I was as far from the capital of Virginia as you possibly could be in the state. So, you know, the argument could be, “I’m so isolated.” But in today’s world, both medical and dental software is such that we undergo continuous audits. Insurance companies look very closely at our submission’s histories or trends. If we fall outside of what they consider the norm, we are flagged. 

Nobody’s isolated. So, a lot of people look at it and go, you know, “I don’t think you guys are going to look at me – why would they care about me? I’m in the middle of Podunk Egypt. Nobody knows who I am!”  

But in today’s world, nobody is isolated. We’re all out there. So, another argument could be, you know, “I’m just a little guy. I’m just doing my own thing here; I’m doing it because I love my patients.” But in today’s world, things can be twisted. 

So, like I said, it’s a matter of having systems in your practice that identify and correct errors, as is required. Your documentation should the bullet proof. 

Jeff Segal, MD, JD 

An ounce of prevention equals a pound of cure, then. 

Roy Shelburne, DDS 

Exactly. Exactly. 

Jeff Segal, MD, JD 

Roy, how can a professional get in touch with you to learn more about who you are and what you do? 

Roy Shelburne, DDS 

Email would be great. I spend a lot of time on the road. But in today’s world, we can always have access to e-mail. Email me at royshelburne@gmail.com.

Jeff Segal, MD, JD 

royshelburne@gmail.com. Perfect. And you have a website also, do you not? 

Roy Shelburne, DDS 

I do.  It’s www.royshelburne.com. 

Jeff Segal, MD, JD 

Perfect. Any final thoughts or things that we haven’t touched on yet? 

Roy Shelburne, DDS 

Good question. Be careful. A lot of people who speak on these topics say that they don’t want to scare you. I’m not that guy.  

I want to terrify you. 

But I also want to give you tools that you can implement to protect and defend yourself. You only need to be fearful if you choose not to act. So, have a healthy concern. But understand – ignorance is no excuse. Understand what you need to establish and maintain in your practice. And if that’s the case, you’ll be fine. 

Jeff Segal, MD, JD 

Since everybody is gonna be in the crosshairs, just show up with your vest. That’s the take home message and it’s a powerful one.  

Roy Shelburne, DDS 

Absolutely.  

Jeff Segal, MD, JD 

Listen, thanks so much for joining us today and I appreciate just getting to know you. You’ve got a very strong message and an upbeat attitude, and I hope we get a chance to speak again on the podcast. So, thanks for joining us today. Bye-bye. 

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Meet Your Hosts

Roy Shelburne, DDS

Speaker, Consultant, Writer, Coach

royshelburne.com

Roy S Shelburne, DDS is a 1981 Honor Graduate from Virginia Commonwealth University’s School of Dentistry. After graduation, Roy opened his practice in his grandfather’s old hardware store. He has served as president of the Southwest Virginia Dental Society and has volunteered at Virginia’s various MOM projects across the state.

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