Next Week On The Blog: Jeanmarie Loria sits down with her partner Eric Rubenstein, retired OIG Agent, to ask him why he had more cases on pharmacy pain management and DME than dental fraud.  Dental fraud stinks worse than the most severe case of halitosis.   

Picture this.  

Brooklyn NY 1960. All 5 of the Lupoli kids are getting dental work, dental work, and more dental work.  Why?  Because their father just took a job that had dental insurance.   

What was the dentist doing to these kids, ages 7 – 18? He was putting caps on every tooth plus fillings, x-rays, filing their teeth down to tack-sized pieces that would cause them a lifetime of mouth pain and endless appointments. Dr. Rothman on Nordstrom Avenue was doing all of this after-hours dental work and billing the insurance company.  

Years later, even more work was required to combat the effects of the pain he caused during the first round of dental work. Roots canals because the crowns couldn’t be removed, which means poor work is done, then redone without any regard for the patient, in this case, children. Bad teeth can be detrimental to a child’s confidence. If kids feel insecure about wearing glasses, imagine the damage done by overzealous dental work.  

Has the dental world changed since the 60s? We’re glad you asked. Next week, we’ll be publishing the tale of a modern-day, unlicensed dentist performing work in his own home, putting patients in a 1950s dental chair, using antiquated instruments. This will be brought to you by one of our Retired OIG Agent staff members, who have seen countless unscrupulous providers blatantly disregarding patient safety for an extra dollar.  

According to the National Health Care Anti-Fraud Association, of the $250 Billion spent on dental care procedures annually nationwide, an estimated $12.5 Billion (or 5%) is lost to dental fraud, waste, and abuse.  

If you know Jeanmarie, then you know that she enjoys the dentist and considers it a luxury. Growing up without dental insurance, going to the dentist always felt like a big deal. This was the impetus for Jeanmarie’s rhetorical tagline: “If insurance pays for, why should I care?” For some reason, many Americans only care what’s billed when they’re the ones paying for it. Patients should care regardless of who foots the bill, and provider transparency is something that the Advize team advocates for every day.  

If a tree falls and nobody is around to hear it, did it still fall? Yes. If a provider commits fraud and nobody detects it, is it still fraud? Also yes.  

This week’s focus on dental fraud has us exploring the concept of payment responsibility and medical involvement. If the patient has to pay, do they care more? Of course. So, the question remains…who does the dental audits? Who cares about the integrity of the claims? Is dental fraud overlooked so often because dental practices are often small than clinics? Let us know what you think.