Have You Been Accused of Dental Insurance Fraud?

 Posted on July 22, 2022 in Medical License Defense

Our professional license defense law firm has written extensively about the serious consequences physicians face if they are accused of medical insurance fraud, including loss of medical license even criminal charges. However, dentists can also be accused with insurance fraud and face the same type of consequences. If you have been accused of dental insurance fraud, contact an Illinois professional license defense attorney right away.

Dental Insurance Fraud

Dental fraud is any intentional misrepresentation or deception of treatment needed in order to obtain unauthorized benefits. According to the National Health Care Anti-Fraud Association, more than $12 billion is lost to dental fraud every year.

One method of fraud that is becoming more common is the alterations of digital X-rays using software programs to create images that show bogus tooth decay, missing tooth structure, lesions, fractures, and more.

Some of the more common types of dental insurance fraud that can result in serious charges include the following:

• Billing for dental services the patient never received

• Misrepresentation of services

• Misrepresenting dates of service

• Overcharging for routine services

• Recommending incorrect treatments

• Recommending unnecessary treatments

• Upcoding routine services

• Waiving co-payments or deductibles

Charges of dental insurance fraud can result in civil fraud penalties, suspension or loss of dental license, and even criminal charges with prison time if convicted. Even if the allegations of dental fraud are eventually reduced or dismissed, the charges become public record and can end up destroying a dentist’s reputation and their dental practice. 

Unaware of the Fraud

It is not uncommon for dentists and other dental professionals to only be focused on the clinical side of their practice, leaving the administrative side, including billing, to other professionals that they have hired.

Unfortunately, if any of these administrative professionals are committing insurance fraud, whether intentional or in error, it does not absolve the dentist of legal liability. Dental insurance companies recommend that every dental office have a written fraud policy in place that is reviewed with staff. It is also recommended that dental professionals either conduct periodic audits or hire an outside company to conduct the audits.

Call an Illinois Professional License Defense Lawyer

If you have been accused of dental insurance fraud, call The Law Offices of Joseph J. Bogdan, Inc. at 630-310-1267 to schedule a confidential consultation with an experienced Illinois dental license defense attorney. It is important not to delay retaining an attorney. Not only could you be facing loss of your dental license, but depending on the circumstances of the allegations, you could also be facing criminal charges.

Sources:

https://www.dentistrytoday.com/nefarious-manipulation-of-digital-dental-radiographs/

https://phmic.com/dental-fraud-12-5-billion-dollar-problem/