As an auditing firm, we are well aware that dental fraud is alive and well in the American healthcare system. With so many American children covered by Medicaid, dentists have taken it upon themselves to begin offering unnecessary and Al-La-Carte services in order to maximize profits. Many offices justify this unethical practice by mentioning that the cost of services doesn’t matter – but it does.Tax payer money is spent to cover procedures and services that were never required, and often times – never asked for. We have identified this trend in our professional lives for many years, but only recently have we noticed that this fraudulent activity has become so mainstream that we have to be vigilant about who is seeing our children.
Our team members have shared a number of stories in which their dentist attempted to perform and bill for services that were not desired or deemed necessary:
“Yesterday I took my sons to the dentist because they both needed 3 fillings. My youngest son was lying comfortably in his dental chair, smiling and watching the brand new flat screen TV that was on the ceiling. Each room has one! The dental assistant then came into the room and said, “Mom, are you familiar with nitrous? We want to give it to him to relax him a bit.” I wanted to laugh. My son was completely relaxed and entertained, so I said “No thank you”. A few moments later the dentist came in and sat down, then order the assistant to “Please start nitrous”. My son was still sitting comfortably, completely un-fazed by the environment. The assistant replied, “No, mom refused”, and proceeded to look at me like I had to two heads.”
This instance of pushing a billable service on a patient in a situation where it has already been declined and deemed unnecessary is a common example of how dentist’s offices are flying under the radar and using patients to make a quick dollar.
Yet another questionable practice involves the removal of deciduous teeth.
“My step-son went to the dentist with his father, who is less aware of these unsavory practices. The dental assistant told him that they were going to relax my step-son when they do the fillings. The dental assistant also said that they would ‘wiggle,wiggle’ his loose front teeth. My husband said okay, and allowed our son to get the nitrous. ‘Wiggle,wiggle’ is also informed consent for deciduous tooth extraction in this office. I should mention that my step-son had no visible crowding, no decay, and no teeth pushing up behind them.”
In a visit for a routine filling, this child was subjected to two additional, billable services. Sadly, this culture of fraud and profiteering has become the norm. Dentists believe they can perform any services they want to because patients won’t care about the bill.This isn’t the case. Patients and tax payers do care about where their money is going, and providers from all specialties need to put patients before profits in order to maintain the integrity of the industry.