Is Your Dentist Committing Insurance Fraud?

Unfortunately, there are very few professionals in this world who are immune to fraud. Even the most trusted individuals in our lives – the doctors, nurses, teachers and even dentists – can be corrupted in the pursuit of money and security. If your dentist is committing insurance fraud in your name, you could potentially be liable for a portion of the fraudulent claims. In some cases, medical professionals have been caught committing insurance scams with their patients.

It is actually quite easy for a dentist to commit insurance fraud. He or she simply writes up procedures that were never performed to inflate insurance payments. Since most patients don’t thoroughly inspect their records before leaving the office, no one is ever the wiser and the dentist makes a quick buck. Plus, medical procedures – even in dentistry – are often unintelligible by name to laypersons.

Of course, insurance companies are aware that fraud occurs, and if they discover it, they will pursue whatever recourse the law allows in their state. This could mean investigating not only dentists and dental assistants, but also the patients who didn’t receive treatment recorded in their charts. For example, if your dentist claims that you received ten root canals over the last few years, and you haven’t received any, you could be on the hook.

Through the course of their investigation, the insurance company will subpoena your dentist’s financial records to determine if payouts where made to patients in exchange for their cooperation. In most cases, claims cannot be made against patients unless a financial trail exists, which means you’ll need to comply with the investigation once you’re made aware of it. This might mean turning over bank statements and W-2s, but it’s worth it if you are cleared.

To keep your dentist from committing insurance fraud in your name, you’ll need to be more vigilant about your medical records. Patients are entitled to see their charts whenever they wish – it’s a right afforded to Americans by law – so you might want to take a look at them every once in a while. If you see a notation that you don’t understand, ask your dentist to clarify what it is. If it isn’t a satisfactory response, you can take it to another dentist to inquire.

Furthermore, it is a good idea to keep track of your insurance paperwork. If you think that your dentist might be committing insurance fraud, contact your insurance company or your employer to ask them to investigate. Explain that you’ve seen some unusual claims on the forms you’ve received, and although you don’t want to be an alarmist, you want to ensure everything is done by the book.

Remember, when dentists and other medical professionals commit insurance fraud, it drives up the cost of insurance for everyone else. Many insurance companies have been pushed into bankruptcy because of these types of situations, which means that Americans must be vigilant about keeping track of their records. You might not want to think that the friendly guy in the white smock is using you to make thousands of dollars, but unfortunately it happens every day.