5 Biggest Dental Fraud Scams

How to avoid dental fraud risks: Internet Scambusters #647

Sitting in the dentist’s chair can be scary enough without also worrying that you’re being taken for a dental fraud ride.

Although most dentists are ethical and honest, a few are ripping off their patients and insurance companies to the tune of thousands of dollars.

In this week’s issue, we explain the most common risks and the steps you can take to minimize the danger of falling victim.

Now, here we go…


5 Biggest Dental Fraud Scams


Have you ever felt seriously uncomfortable in the dentist’s chair — not because of the procedures you face but because you’re worried about dental fraud?

It’s a legitimate fear. Dentists, like all medical experts, know far more about your needs than you probably do, so you have to take them at their word.

But a small number of dentists are exploiting this — ripping off patients and insurance companies with inflated billing and unnecessary treatments.

In search of evidence, the magazine Readers Digest sent an investigator on assignment to check out reports of dental scammers.

He visited 50 dentists in 28 states and, although he had healthy teeth (apart from possibly needing one crown), he received estimates for work ranging between $460 and almost $30,000!

The high bid included 21 crowns and 6 veneers.

While it’s true that professional expertise might vary from one dentist to the next, the discrepancy here is so wide it’s hard to put it down to merely differences of opinion.

This is borne out by comments from the Coalition Against Insurance Fraud.

In a website section devoted to dental fraud, it says: “Most dentists are honest, ethical professionals who provide their patients competent and caring treatment.

“A small but disturbing number of dentists, however, are dishonest. They exploit their position of authority to bilk trusting patients with useless and often painful treatment, and shady billing practices.

“These dentists want to line their own pockets with insurance money — often jeopardizing your own health and coverage.”

The organization lists five main dental scams:

  1. Worthless treatment. This includes unnecessary work and removal of healthy teeth.
  2. Inflated billings, where unscrupulous dentists bill for costlier work than the procedure they actually performed — the practice is known as “up-coding.”
  3. Phantom treatment. Similar to #2 above, but this time the dentist bills for treatments they haven’t even performed or for medications they haven’t provided.
  4. Unlicensed dentists and employees. This may refer to dentists treating patients after losing their license or to employees carrying out procedures they’re not qualified to do.
  5. Fake dental plans. Worthless “policies” sold by telesales or other high-pressure tactics that victims don’t find out about until they make a claim.

Although some of these scams chiefly target dental insurers, it’s also perfectly feasible for a dentist to tell individual self-paying patients they need unnecessary work or that they’ve carried out procedures that they really haven’t.

In a 2013 op-ed piece for the American Dental Association (ADA), one leading dentist criticized some members of his profession for what he labeled “creative diagnosis.”

He said the disparity of diagnoses he had recently witnessed over 34 years of practice was alarming.

He was particularly concerned about diagnoses and treatments for children, especially the use of X-rays and unnecessary treatment to first teeth.

“Are you increasing the creative diagnosis portion of your practice?” he asks his fellow members. “Is creative diagnosing becoming a new skill in the dental profession? I hope not — for the sake of our patients and profession.”

So, is there anything you can do to ensure you or your family members aren’t victims of dental scams, or unwitting participants in dental insurance fraud?

First, be aware of the most common sources of unnecessary or over-extreme treatments. These include gum grafts, use of adult braces, performance of root canal procedures, and tooth whitening.

That’s not to say these procedures are always unnecessary but they are the ones that give rise to most suspicions.

There is also a lot of legitimate disagreement about removing and replacing amalgam fillings. The U.S. Food and Drug Administration says amalgam is safe.

Some dentists agree, such as Dr. Stephen Barrett, an MD and founder of the online watchdog Dental Watch. He is quoted in one investigation as saying: “If a dentist says you need to have amalgams removed because they’re toxic, head for the exit.” Other dentists truly disagree, so we recommend you do your own research.

He also lists so-called “bite-balancing” for adults and putting crowns on healthy teeth as other dubious practices.

Follow your gut instinct and question the dentist closely on why he or she believes the treatment is necessary.

Second, check out the reputation of your dentist and their membership of your state dental board. Has the dentist ever been disciplined either by state bodies or his/her professional association?

What do patients say about the dentist online and who do your neighbors and friends recommend?

Third, if your treatment is partly or wholly paid for by an insurer, carefully check your Explanation of Benefits to make sure it lines up with the treatment and medication you’ve received.

Fourth, seek a second or even a third opinion. There’s nothing wrong with doing this. Ask the first dentist for a written diagnosis or treatment plan and then say you want some time to think it over.

If you’re anywhere near a dental training school, see if you can arrange your second opinion there. It’s much more likely to be objective.

Fifth, if the treatment is for your child, always question the need for anything more than basic X-rays, stay in the surgery when the child is being treated, and make sure the dentist is a board-certified pediatric dentist.

Sixth, be wary about dental plans sold through telesales or other high-pressure techniques. If you’ve never heard of them or they don’t check out online, give them a miss.

And finally, of course, take good self-care of your teeth and oral hygiene. That way, things are less likely to go wrong — so you’re more likely to avoid coming into contact with the dental fraudsters!

Alert of the Week

A new and dangerous scam targeting PCs, smartphones and mobile device users claims you have new messages on the social networking site WhatsApp.

It may appear to have come from a trusted contact and has a “Play” button, which leads to trouble if you click.

You’ll land on what seems to be a random page selling something or other — from diet plans to rally autos.

More worrying, some reports suggest the malware it contains hijacks Gmail address books and then spams all your contacts.

If you use WhatsApp, go directly to the site to check for new messages. Don’t click the button!

That’s it for today — we hope you enjoy your week!