According to a report by the U.S. Department of Health and Human Services, more than 5,000 communities in the US lack adequate access to professional dental care, which is defined as having fewer than one dentist per every 5,000 residents. According to the American Dental Association, about a third of American dentists are age 55 or over and thus close to retirement…meaning this shortage will most likely worsen over the next few decades.
This situation seems to have exacerbated a rise in dental scams, as well: with less competition, apparently a few unscrupulous practitioners feel they can treat patients shoddily without serious repercussions. While most dentists are caring and ethical, there remains a small (but still disturbing) number who are dishonest, abusing their positions of trust and authority to cheat patients and insurance companies out of an estimated $12.5 billion a year, according to the National Health Care Anti-Fraud Association.
We’re not just talking about shabby work (although that is becoming more common in some circles, as well); the core of the problem is an increase in what can only be described as out-and-out fraud. The most common example of this would be performing treatment that is unnecessary or pointless.
It must be acknowledged, of course, that dental diagnoses can be extremely subjective: even honorable dentists may take a more aggressive approach to treatment than others in the field. Having said that, some deliberately and blatantly overdo it—doubling up on X-rays, drilling for nonexistent cavities or extracting perfectly good teeth—simply for financial gain.
Or instead of performing unnecessary work, a dentist may “upcode”: charge for a more expensive procedure than the one actually completed. For instance, a dubious practitioner might bill a basic cleaning as something much more complex and costly—such as an extraction—and pocket the extra cash. In worst-case scenarios, the dentist might even bill for doing nothing at all: when billing for services not rendered is simply a matter of adding an extra procedural code or two, shysters can view doing so as easy money at the insurance company’s expense.
These practitioners count on the fact that even patients who scrutinize their explanation of benefits (EOB) often miss upcoding or miscoding because names and codes for closely related treatments can be similar. Dentists should be warned, however, that the Dental Health Alliance publishes a list of the dental codes which are most frequently used in fraud. Access to this list can make it easier for sharp-eyed customers to see through the ruse, resulting in a credit card chargeback to the dentist…or worse, a report to the ADA.
Other tricks can be just as effective. Any modern dentist should know there is no evidence that amalgam fillings are hazardous to a patient’s health. But shady docs might suggest that those fillings—which DO contain mercury, but only at extremely low levels—are leaking and need to be replaced. This fear tactic makes the fillings seem like ticking time bombs, even though the US Food and Drug Administration says it’s not a problem.
Some dentists push the replacement anyway, glossing over the details and necessity of treatment and stressing the urgency. These dental “bullies” insist that such replacement is a routine—and in fact, it may be so in their practice. That doesn’t mean it’s correct…but that doesn’t stop them from applying pressure to have the procedure done, often implying that it will have to be done eventually, so why not now, while the patient is already in the chair?
Dentists who engage in these sorts of practices are a bane to those who deal fairly and honestly with patients. It can seem deceptively easy to cut a few corners here and there, fake a few codes, and gain a little extra income. In the long run, however, such tactics will only serve to give your office a bad name, and may even result in legal action under the False Claims Act. A better way to ensure success is to build a reputation for honest, quality patient care.