The Most Common Digital Red Flags in Dental Lawsuits
The author and curator of this blog is William Hiltz, the founder of Hiltz & Associates and Hiltz Digital Forensics.
In litigation, these tiny anomalies can snowball into major credibility problems.
THIRD IN A SERIES—PART 3 OF 5
Digital red flags often do not appear as the proverbial “smoking gun.” Red flags are usually found as small inconsistencies, such as a timestamp that doesn’t line up, a missing image, a late entry with no addendum, or a log-in at an unusual time of day.
This post focuses on the red flags that most often escalate routine complaints into full‑blown legal disputes, with a clear comparison of how these issues play out under American and Canadian regulatory frameworks.
Late or Backdated Clinical Entries
In 80% of the cases where defense counsel retained me as an expert, I discovered that the dentists had made late and backdated entries.
William Hiltz
Late entries can be a big red flag
Courts and regulators assume that contemporaneous notes are accurate. When entries appear days or weeks after treatment, opposing counsel often argues that the record was “cleaned up” after the fact. Courts take a dim view in this regard.
Forensic tools can detect:
- Edits made after a complaint was filed
- Deleted entries, and attempts to overwrite or hide data
- Metadata inconsistencies
Even innocent, well-intended corrections can appear suspicious without proper analysis.
| U.S.A | CANADA |
|---|---|
| HIPAA doesn’t prohibit late entries, but audit logs must show the true timestamp. Many states (e.g., California, Texas, New York) treat backdating as professional misconduct. Malpractice insurers routinely request audit logs when late entries appear. | Provincial colleges emphasize addendum‑based corrections, not overwrites. Backdating can trigger professional conduct investigations, even without a lawsuit. Canadian regulators can request entire audit trails, not just the electronic dental chart. |
Missing or Altered Imaging Files
Imaging is often the most objective evidence in a dental case.
Missing images or metadata inconsistencies raise immediate suspicion.
| U.S.A. | CANADA |
|---|---|
| Imaging metadata is frequently subpoenaed in malpractice cases. Plaintiffs’ attorneys often hire forensic experts to analyze DICOM metadata. Deleting or modifying images can be argued as spoliation of evidence, which can shift the burden of proof. | Provincial regulators expect full retention of original images, including failed or retaken shots. Missing images can lead to quality‑of‑care investigations, even if the clinical outcome was reasonable. Canadian courts are increasingly receptive to digital forensics in imaging disputes. |
Suspicious Patterns in Audit Logs
Audit logs are the digital equivalent of security camera footage. Unusual patterns can imply tampering or unauthorized access.
Forensic analysts can reconstruct minute‑by‑minute sequences of events, showing exactly when:
- Notes were entered
- Images were captured
- Billing codes were applied
- Records were accessed
- Records were deleted or modified
Audit logs are used to establish a timeline trail of evidence to demonstrate “who accessed what, and when”—which in many cases becomes the entire legal argument.
| U.S.A. | CANADA |
|---|---|
| Unauthorized and suspicious access can lead to: Civil penalties OCR investigations Plaintiffs’ attorneys often request full access logs to check for post‑incident chart activity. | Unauthorized and suspicious access can trigger: Regulatory discipline Privacy commissioner investigations Plaintiffs’ attorneys often request full access logs to check for post‑incident chart activity. |
“Missing Data” Server, or Backup Anomalies
When a dentist claims “my system crashed” or “the backup failed,” courts and regulators want proof.
| U.S.A. | CANADA |
|---|---|
| Data loss can be interpreted as negligence or spoliation if backups weren’t properly maintained. | If backups weren’t kept up to date, data loss might be considered negligence. |
Inconsistent Timelines Across Systems
Why it’s a red flag
When timestamps in the practice management system don’t match imaging software or billing logs, it suggests tampering—even if the cause is innocent (e.g., a workstation with the wrong clock).
| U.S.A. | CANADA |
|---|---|
| Digital forensic experts often reconstruct timelines across PMS logs, Imaging metadata, Billing submissions, Email servers, Windows Event logs Timeline inconsistencies can undermine the dentist’s credibility. | Lawyers and regulators frequently request multi‑system timelines during investigations. Even minor inconsistencies can be interpreted as poor record-keeping, which is a standalone offense in many provinces. |
Why These Red Flags Matter More in 2026
Both America and Canada are tightening their expectations around digital integrity:
| U.S.A. | CANADA |
|---|---|
| America has seen an increase in litigation, aggressive discovery by plaintiffs, and federal enforcement. | Canada has strong privacy laws, more active regulatory involvement, and growing use of digital forensics in investigations. |
The message is clear for dentists on both sides of the border: your digital footprint is now part of your legal defense plan.
