Dental FraudBusters!
Dental FraudBusters!
"I am on a mission to help dentists better understand, prevent and confront issues related to fraud, embezzlement and employee dishonesty in their practice"
Blog By:
Bill Hiltz
Bill Hiltz

47 year old female dentist sentenced to 30 months in jail for healthcare fraud.

47 year old female dentist sentenced to 30 months in jail for healthcare fraud.

5/6/2019 6:30:55 AM   |   Comments: 0   |   Views: 62

47 year old female dentist sentenced to 30 months in jail for healthcare fraud.

"I wanted to bring this story of dentist fraud to your attention because of the similarities with employee fraud - and the potential implications for dentists if not handled properly."
The dentist in this case did three things that landed her in prison. 
She:
        
  1. 1- fraudulently billed insurers for services never rendered
  2.     
  3. 2- billed insurers for services rendered using inappropriate billing codes that resulted in higher bills than were justified by the actual service
  4.     
  5. 3- billed insurers for services performed after the termination of the patients’ insurance coverage and then backdated the claims documents to make it appear that the services occurred when the insurance policies were in effect. 

What happens if your employee steals from insurance companies?

Your employees can steal from insurance companies in the same way, and you can be held accountable  (think Dr. Roy Shelburne
Dental employees can, and do, use similar schemes to "milk" benefits from insurance companies.
A problem for dentists is when an insurance company detects false claims coming from your office, they  will focus attention on you. 
Most insurers will think that you have "dirty hands" and were involved or knew about the thefts.
In order to defend against any allegations or claims, the best approach is to use the "clean hands" approach and clearly demonstrate that you had:
        
  1. - No knowledge that your employee was making fraudulent claims
  2.     
  3. - you did not instruct or guide your employee to commit fraud
  4.     
  5. - you did not consent or authorize your employee to commit fraud 
  6.     
  7. - you were not "willfully blind" to your employees actions.
In every case** where employees were submitting fraudulent claims to insurance companies, I was successfully able to advocate "clean hands" for my clients to the insurers, which placed the onus and focus on the employee.
**in every case except one , when the dentist really had "dirty hands".   When insurance companies started asking questions, I was hired to investigate the office manager, who the dentist claimed was responsible.  
It was a smoke and mirrors game, which the dentist lost.  I ultimately had to sever my engagement with this dentist.
He was charged, but did not go to prison. He did lose his license for a period of time, paid hefty penalties and moved to a different state where he now practices.

Story is here:
https://www.justice.gov/usao-edva/pr/dentist-sentenced-prison-783k-fraud-scheme
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