Found out my dentist has been over billing

[scottmandue]

Been seeing the same dentist for +20 years with no problems.
Got married seven years ago and wife started seeing the same guy and liked him.

He is getting close to retirement so I found us a new dentist.

Wife has pain and goes to the new guy who sends her to a specialist thinking she may need a root canal.

Specialist takes some X-rays and looks at my wife's records...

Long story short old dentist has billed for a lot of work that apparently was not done.

Specialist is going to report back to the insurance and old dentist is going to be investigated.

Question is how is that going to affect us?

[drcoastline]

If it was paid by insurance it probably won't affect you other than maybe reimbursement for copay. But that would come from dentist not insurance.

[Nickshu]

Doesn't sound good for the dentist. As a dental specialist myself we see everyone's work... If you want to find the best dentist in your area call a periodontist in the area and ask.

Having served on the state dental peer review board myself if this is true this guy will at least get his license suspended or revoked. The real damage will be audits and fines from insurance if he was a network provider.


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[scottmandue]

Yeah, not good for our old dentist... but he made his bed.

What really sucks is my wife may need a root canal and crown... and the old dentist already billed for that (tooth has not been touched, that is what sent out a red flag to the specialist) and if we need to go ahead with that we will have to pay out of pocket.

[drcoastline]

Originally Posted by scottmandue

Yeah, not good for our old dentist... but he made his bed.

What really sucks is my wife may need a root canal and crown... and the old dentist already billed for that (tooth has not been touched, that is what sent out a red flag to the specialist) and if we need to go ahead with that we will have to pay out of pocket.

Maybe not. If there is indication (x-rays) that the tooth wasn't worked on good chance it gets paid and dentist is sued for fraud. The billing relationship is between the dentist and insurer.

[Bob Kontak]

Originally Posted by scottmandue

... and the old dentist already billed for that (tooth has not been touched, that is what sent out a red flag to the specialist) and if we need to go ahead with that we will have to pay out of pocket.

Co-pay on that stuff is usually half if you are fairly well insured. $750 (several years ago)

$750 root canal. $750 crown. Then the $750 x 2 the insurance won't pay.

That's $3,000+ for a toof.

Ouch!

[Nickshu]

Originally Posted by Bob Kontak

Co-pay on that stuff is usually half if you are fairly well insured. $750 (several years ago)

$750 root canal. $750 crown. Then the $750 x 2 the insurance won't pay.

That's $3,000+ for a toof.

Ouch!

Yup. The sooner you accept that aside from cleanings and x-rays dental care is largely an out of pocket expense, even with "insurance", the better off your oral health will be.

[Steve Carlton]

Is it safe?

[Gogar]

Wait so your dentist billed you for a root canal and crown on a tooth that never saw any work?

That's terrible, AND

What were you doing wherein you didn't catch it? I mean, respectfully.

[Nickshu]

A couple thoughts....My guess is the endodontist you saw knows about this guy and this habit, he's probably seen it before from him but never wanted to report it because he's lose the referral. Your wife may have been the last straw. My practice is referral based too, sometimes you have to look the other way on some borderline stuff, but something like this that is totally blatant you cannot ignore.

Another thought, I have seen cases where a dentist's front desk is overbilling but the dentist is unaware it's going on. I have also seen cases where the front desk staff is overbilling and embezzling the difference between the work actually done and the work billed for. Ultimately the practice owner/dentist is responsible but in a busy practice it's easy for stuff like this to fly under the radar.

When I was on the state peer-review committee we saw a few front desk financial coordinators go to prison over stuff like this, often they are repeat offenders and the change jobs when they suspect their boss is getting suspicious, only to do the same thing at their new job. In my practice we have had a forensic accountant go thru our books and billing practices a couple times in the past to look for stuff like this, amazing how skilled embezzlers can be.

Again just a couple more thoughts, it does sound like this was more blatant from your description.

[Steve Carlton]

So, it's not safe.

[The Synergizer]

They may have to remove all her teeth and store as evidence.

[stomachmonkey]

Does your wife go under when she's worked on?

I've had a root canal and crown.

Kinda hard to not know the work has not been done unless you are out cold.

[Bob Kontak]

Originally Posted by Steve Carlton

So, it's not safe.

No, it's not safe. It's very dangerous. Be careful.

That hurt? I should think it would.

[scottmandue]

Originally Posted by stomachmonkey

Does your wife go under when she's worked on?

I've had a root canal and crown.

Kinda hard to not know the work has not been done unless you are out cold.

We were not being notified by the insurance company of all the bogus work he was billing for.

Not sure how that happened because we usually get something in the mail saying X work was done and your copay is Y.

I may be guilty of looking at the bottom line and if it says zero copay tossing it in the recycle bin... but I'm pretty sure I would have noticed a root canal that wasn't done.

[cnielsen]

Sometimes there is a discrepancy in tooth number, either by accident or in the case where there are other missing teeth. Rule that possibility out first. Otherwise, this won't turn out well for the old dentist. If it was a cash deal between you and him, that's one thing...but this could turn into a full blown insurance fraud case

[stomachmonkey]

Originally Posted by scottmandue

We were not being notified by the insurance company of all the bogus work he was billing for.

Not sure how that happened because we usually get something in the mail saying X work was done and your copay is Y.

I may be guilty of looking at the bottom line and if it says zero copay tossing it in the recycle bin... but I'm pretty sure I would have noticed a root canal that wasn't done.

OK, had more coffee, got it.

He did not tell your wife "you need X" and then did not do it.

He just made up **** and billed insurance.

[scottmandue]

Originally Posted by stomachmonkey

OK, had more coffee, got it.

He did not tell your wife "you need X" and then did not do it.

He just made up **** and billed insurance.

Yep, sad to say because old dentist seems like a nice guy (I know,when they find a serial killer all the neighbors are "he seemed like such a nice guy!")

Old dentist is getting ready for retirement (and his work was slipping, that is why I moved us to a new dentist) maybe this is his way of building up a retirement fund?

Sad because I presume he has been doing this with all his patients and now he has been found out he is going to be in deep doo-doo.

[pavulon]

People like this dentist who at the end of their career see their life's work come apart at the seams are at high risk for suicide.