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Unprofessional conduct of fraud is like deceiving your clients or patients which is like gaining unauthorized benefits. Such action could result in criminal charges and could put your license at stake. If such a thing happens, you as a dentist should be prepared in facing such a case by hiring a dental attorney.

In December 2016, the Insurance Department conducted an investigation after receiving information that the dentist was suspected of committing fraud. They have found that several families received numerous root canals far in excess of the average for their company, and provided an example where the dentist submitted claims for 118 root canals performed on a family of four within a three-month time period. The Insurance Department obtained records, interviewed patients and insurance carriers, and executed a search warrant on the dentist’s dental office in Galveston, Texas, on April 12, 2017.

The investigation revealed that from approximately January 1, 2008, through March 1, 2018, The dentist knowingly submitted dental claims to 10 insurance carriers’ for payment of dental procedures that were not provided to the insured patient, or double-billed by submitting claims to more than one insurance carrier for payment without informing the carrier of the other policy. The investigation found that the dentist’s fraudulent conduct involved excessive billing for both root canal procedures and fillings.

In other cases, the dentist submitted claims for patients she had never seen, billed for completion of up to 40 root canals a day, and submitted claims for appointments on days when the office was closed, it was a holiday, she was not working that day, or the patient was out of the country. The dentist continued submitting fraudulent claims even after the search warrant was executed and she was interviewed by the Insurance Department.

The number of fraudulent claims submitted totaled $1,243,811.00. Payments made to the dentist by the insurance carriers on these fraudulent claims totaled $504,216.76.

On December 11, 2019, a 76- count first-amended felony was filed charging the dentist with violations of making false healthcare insurance claims in excess of $950, from 2014 through 2018. Many insurance carriers were affected by the dentist’s fraudulent conduct.

As a result, the dentist was disciplined by the Dental Board and was convicted for Healthcare Insurance Fraud, a felony violation or offense that substantially related to the qualifications, functions, and duties of a dentist.

Unfortunately, the dentist was unable to hire a dental attorney which led to his unluckiness.  When facing such a case, it is imperative to have a dental attorney as your representative in court. As it is also important that you should know how your case will go.

If you received a complaint regarding a case or complaint filed on you, you should hire a dental attorney immediately before it’s too late. Texas dental attorney Yong J. An is one of those dedicated dental lawyers who helped various dentists in their cases since 2006. You may contact him 24/7 at (832) 428-5679 for more information or if you want to schedule a private consultation.