Dental Fraud Cases
“ANGOLA, Ind. - A dentist accused of diagnosing cavities that did not exist will not face prison time, according to an agreement filed in Steuben Circuit Court.
Louisville, Ky. oral surgeon Robert Michael Clear has been sentenced to three years in prison on felony Medicaid fraud charges according to Attorney General Greg Stumbo.
The Jefferson Circuit Court sentence was probated for five years on the condition that Clear pay restitution to Medicaid in the amount of $18,175.66.
BY Jim Muir
BENTON - Benton dentist Dr. W. David Rommel was sentenced to 63 months in federal prison and ordered to repay $827,000 to the Illinois Department of Public Aid during a sentencing hearing Tuesday morning in U.S. District Court in Benton.
Dr. Alan I. Aronowitz was sentenced this week to four years in jail and ordered to pay $200,000 in restitution to United Concordia insurance after pleading guilty to using unlicensed assistants to perform root canals.
Aronowitz’s lawyer had argued that white-collar criminals should not get jail time.
There’s an attitude that poor people should go to jail, but wealthy educated people should do community service.
“The lawyer is implying that fraud isn’t so bad,” says Robin Mathias, a healthcare fraud control specialist. “There’s an attitude in this country that if a mother steals to feed her kids and pay the rent, she should go to jail, but if a wealthy person steals to get a vacation home, that person should just do community service. This attitude increases healthcare fraud not only because perpetrators think they are unlikely to go to jail if caught, but also because they often convince themselves that what they’re doing isn’t wrong.”
“It’s all about the money,” was the operating creed of Hatch Dental, as described in a 42-count felony complaint filed by California Attorney General Bill Lockyer on September 22, 2004. The complaint describes how 20 defendants affiliated with three Hatch Dental clinics let greed rule their practice at the expense of patient health and safety.
In spring of 2002, when Brian Kanarek, DDS asked defendant Kyon Maung Teo (the alleged ringleader) why he over-diagnosed treatment, Teo told him, “Something has to pay for this practice.” After Kanarek diagnosed only 2 fillings for a patient whom Teo diagnosed 26, Teo told him to leave Hatch Dental “and don’t come back.”
September 29, 2004 the Florida Attorney General announced that Dr. Suzanne Abergel-Nahon had used unlicenses staff to perform dental procedures for Florida Medicaid patients. The scam cost Florida Medicaid at least $260,000. From January 2000 to August 2004, Dr. Abergel-Nahon submitted claims for more than $3 million. Some of those claims were for services such as fillings, crowns, extractions, dentures, and root canals that were billed as if she provided them, when in fact, unlicensed staff performed the services.
Florida officials were probably able to find the fraud because of high billing by the provider. Data analysis algorithms can identify dentists who have such high billing it is unlikely that they could have performed all the work themselves. Once the dentist has been flagged, a simple investigation involving some phone calls and a site visit can identify who works for the dentist, what licensing they have and who actually performed the services.