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Do dentists commit health care fraud?

On Behalf of | Mar 29, 2022 | Criminal Defense, Felonies

When people visit an Illinois dentist’s office, they typically expect an accurate assessment and quality care. Some patients receive bad news about a tooth’s condition, so getting a crown or scaling becomes necessary – or so the patient thinks. Surprisingly, an unethical dentist might perform a procedure that isn’t necessary, such as filling a cavity that did not exist. Such an action would be one example of health care fraud.

Dentists pushing for procedures

A dentist might seem unreasonably pushy about performing a particular treatment. A patient could find this behavior odd but may not understand why the dentist would be intrusive or impatient. Perhaps the dentist advocated an unnecessary procedure and didn’t want the patient to get a second opinion or otherwise not go through with it.

Questions arise about why a dentist would perform unnecessary procedures. Often, the dentist wishes to make more money and does so by committing malpractice and fraud. If the patient carries sufficient insurance, the dentist may bill the insurance company for the procedure. Neither the patient nor the insurance company may learn the dentist committed fraud.

Health care fraud and its consequences

A dentist could get away with committing health care fraud for many years. The practitioner might become comfortable with his or her illicit behavior if no one discovers the activities. However, a worker at the dental clinic may become a whistleblower, or an insurance investigator might notice something suspicious.

Someone committing health care fraud could face felony charges. The charges and penalties might become more severe, depending on the monetary amount involved. Not all charges are valid, though. Sometimes, paperwork mistakes or other misunderstandings could lead to fraud claims. That said, a dentist might also consider a plea bargain deal when the evidence is strong.