Drill, fill and bill: Dental industry fraught with over-billing and false diagnoses

Thursday, September 05, 2013 by: Ethan A. Huff, staff writer
Tags: dentistry, medical ethics, profiteering

(NaturalNews) Have you ever gone to the dentist and felt as though a diagnosis or procedure you received was unnecessary, or that it was billed at a much higher rate than normal in order to extract as much money as possible from your insurance company? A New York man claims that he and potentially thousands of others are victims of this and numerous other types of dental fraud committed by a nationwide chain of dental "mills," which operate solely for profit purposes rather than for providing honest treatment and care.

Shawn Zukoski says a dental chain known as "Small Smiles Dentistry," which provides dental services for children and low-income families, performed a series of unnecessary procedures on him when he was 13 to 15 years old. According to Courthouse News Service (CNS), Small Smiles failed to provide Zukoski with necessary guidance on how to effectively prevent tooth decay and its spread, but was more than happy to administer a series of unnecessary procedures that included 12 fillings, a pulpotomy and crown, two extractions, four temporary crowns, and two root canals.

The complaint, which was filed in New York's Schenectady County Supreme Court, alleges that Small Smiles, five other LLCs or corporations, seven dentists, and a number of others routinely performed "unnecessary, inappropriate, unsafe, and excessive dental procedures on young children" in order to generate obscene profits. The complaint also alleges that the defendants filed fraudulent claims with the federal Medicaid system for reimbursements on these illegitimate procedures.

"A dental clinic chain known as 'Small Smiles,' operating in twenty-two states including New York, performed unnecessary, inappropriate, unsafe and excessive dental procedures on young children," says the complaint. "It (also) received hundreds of millions of taxpayer dollars (to do so)."

Is your dentist putting you and your children's health at risk by performing unnecessary procedures?

Zukoski says he personally suffered a number of injuries as a result of receiving the illegitimate treatments, all of which he says were "below the applicable standard of care." And since Small Smiles operates in 22 states nationwide, the company's fraudulent activity, if found to have taken place as Zukoski says it did, more than likely affects thousands of other dental patients as well.

"[D]entists were required to -- and did -- treat patients with revenue generation as the primary goal rather than the medical needs of the patients," adds the complaint. "[D]entists were expected to -- and did -- perform unnecessary dental procedures."

Over-billing is apparently quite common throughout the entire dental industry, as are unnecessary dental procedures and false diagnoses. The more procedures a dentist can perform and bill insurance for -- and in some cases, not perform and still bill for -- the more money he or she can obviously generate for the practice. According to the National Healthcare Anti-Fraud Association, dental fraud collectively tops $10 billion a year, which is higher than the annual amount for credit card fraud.

Sources for this article include:

http://www.courthousenews.com/2012/09/21/50526.htm

http://www.rdhmag.com

http://www.aaoms.org/docs/practice_mgmt/fraud_and_abuse.pdf