The pitch is appealing. “You pay us nothing up front. We take ten percent of every case we bring you. If we do not perform, we do not get paid.”
It sounds like the fairest deal a marketing company could offer. For a dentist, it is one of the riskiest.
What the ADA’s ethics code says
The American Dental Association’s Principles of Ethics and Code of Professional Conduct include an advisory opinion, 4.E.1, titled “Split Fees in Advertising and Marketing Services”. Its position is that a dentist who pays for advertising or marketing by sharing a portion of the professional fees collected from patients is engaged in fee splitting.
The ADA extended the same opinion in 2025 to cover social media influencers who are paid a share of patient fees. ADA News covered the update.
State law adds its own rules. Many states restrict or prohibit fee splitting between dentists and non-dentists, and some dental boards treat a percentage paid to a marketer as a sign that an unlicensed party is sharing in professional income. The details vary by state.
Why the rule exists
A marketer who earns a share of each case has a reason to push patients toward the most expensive treatment. The rule keeps the person recommending treatment free of anyone else’s financial interest in the answer.
There is a practical problem as well. To get paid on a percentage, the marketing company needs to know which patients started treatment and what they paid. That means asking for information from your patient records, which a marketing vendor should not need.
The arrangements to question
- A percentage of production or collections from patients the marketer “brought in”
- A fee paid only when a lead becomes a patient
- A fee per started case
- “Free” marketing in exchange for a share of the first year of a patient’s treatment
If a proposal has any of these, ask your attorney before you sign.
What to agree to instead
You can still make a marketing company carry risk without sharing a fee.
A flat fee for defined work. A fixed monthly amount for a stated set of services. The fee does not change with how many patients you treat or what they pay.
A guarantee on something the marketer controls. Booked consults are a fair measure. The marketer controls whether qualified people ask for an appointment. Your team controls whether they accept treatment.
A remedy that is not a refund per patient. A free month of service if the guarantee is missed, for example.
Everything in your name. Your site, your Google listing, your data. If you part ways, the work keeps working for you.
No patient records. Results counted from call tracking and booking records, not from charts.
This is how we set up our own agreements: a flat monthly fee and a guarantee on booked consults.
A note on this article
This is general information, not legal advice. Fee-splitting rules differ from state to state. Have a healthcare attorney in your state review any marketing agreement before you sign it.