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Drilling down on dental fraud

| Jun 18, 2021 | Malpractice |

No one said that being a dentist is an easy job. Even achieving a license requires years of schooling and internships. Conversely, few of their patients welcome the need to see a DDS over problems with their teeth.

Behind the scenes, many dentists are frustrated over the reimbursements they receive via private insurance or Medicare. Most do their best to make ends meet through creative marketing and referrals to friends and families.

Others take the easier path, engaging in fraud to pad their practices’ bottom lines. Teeth whitening is pushed when strips found in retail stores achieve the same result. A minor filling results in a more expensive crown to replace a tooth that did not need to be removed.

A pandemic making a bad situation worse

Like businesses in all industries, the COVID-19 pandemic negatively impacted dental practices. Traffic into their offices was significantly reduced. Profits were down, and many dentists engaged in unethical behavior.

Dental fraud is a billion-dollar industry. Many encourage patients to undergo procedures or purchase products that they do not need. Even when more affordable options are available, they recommend significantly more expensive treatments that achieve the same result. The more invasive, the more revenue a practice can generate.

A study from the National Health Care Anti-Fraud Association revealed that Americans spend $3.6 trillion in healthcare. Thirteen billion of that amount is lost to fraudulent acts by dentists. From “creative diagnoses” to outright fraud, patients are being exploited or outright lied to, all in the quest for more profits. Victims range from parents of children with baby teeth to senior citizens with dentures.

Small private practices have become the exception, not the rule over the past 20 years. Corporations, private-equity buyouts, and group practices encourage more pricey options, prioritizing profits over patients’ actual needs. Dentists who do not tow that line are many times pushed out for not going along to get along.

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