In 1993, Dr. David Silber, a dentist now practicing in Plano, Texas, was fired from the first dental clinic where he worked. He was assigned to another patient whose dentist was planning to prepare a crown-a metal or porcelain dental cap to treat broken or decayed teeth. However, Silber did not find any problems with the teeth, so he sent the patient home.

Later that day, he was fired. Someone told him: “Never let patients who are willing to pay for the clinic to leave.”

Silber said that what happened to him is still happening today, and some dentists (whether it is private insurance or Medicaid) who think they are not getting enough benefits from insurance reimbursement have found a way to raise the bottom line. When lower-cost options might accomplish the same thing, they will launch products and procedures that patients don’t need, or recommend higher-cost treatment plans.

Since the COVID-19 pandemic has reduced traffic into the dentist’s office, the pressure is now even worse. However, although most dentists are ethical, the practice of using profitable procedures, materials or appliances is not new.

In 2013, Washington dentist published an article in the publication of the American Dental Association Lament the “creative diagnosis” model.” 2019 research The dental fees found that the prices of certain services vary widely. It said that, for example, tooth whitening in a dentist’s office is not more effective than whitening paper purchased in a pharmacy, and it is at least 10 times more expensive.

But sometimes the dentist will escalate to outright fraud.Recent articles American Journal of Insurance Fraud To be clear: “Medicaid fraud is the most profitable business model in the dental field in the United States today.”

Indeed, ADA saw a problem.Dr. Dave Preble, senior vice president of the Institute of Practice of the American Dental Association, said: “Hundreds of thousands of dental operations are performed safely and effectively every day.” But he cited A study by the National Health Care Anti-Fraud Association In other words, of the 3.6 trillion US dollars that Americans spend on health care each year, 3% to 10% of the funds are lost every year due to fraud.This is equivalent to $13 billion of that Americans spend $136 billion annually Dental care services lost due to dental fraud.

Silber said that after he saw an X-ray of a patient, she had seen another dentist and was shocked to learn that she only needed a small mouth to install two crowns. She was told that the first crown is essential to treat cavities in one tooth, and the second crown needs to make the first crown fit better.

Silber said: “She only needs a small filling. It should cost her about $100.” “Instead, the dentist persuaded her to replace two perfect teeth so that he could earn 2,400 from her insurance company. US dollars.”

In the past two decades, companies have absorbed small private businesses, private equity acquisitions or group businesses have made people pay more attention to higher profits. Silber said: “The chief executive tells the dentists who work for them which procedures to promote, just like a chef tells their team of waiters to promote daily special food.” “If the dentist refuses to obey, they will be taken to the door.”

Quadrant scaling is usually a treatment that forces patients into the company’s dental chain: invasive tooth cleaning procedures along the gum line usually require three to four visits. If the patient has severe gum disease, this procedure may help, but it will erode the gum tissue that cannot grow back. Dentists charge between US$800 and US$1,200 for each procedure, and standard cleaning services can only bring them a net income of US$100.

Dr. Michael Davis, a dentist who practices in Santa Fe, New Mexico, said some dentists are looking for procedures with higher Medicaid costs. He explained that the price of nickel-chromium steel crowns paid by Medicaid is three to six times that of standard fillings. Therefore, some dentists recommend more profitable and more invasive treatments to unsuspecting patients.

Davis said: “The fit of the prefabricated steel crown is inappropriate and there will be gaps. Therefore, unethical dentists will target children until their permanent teeth are inserted. They will not notice the deformed fit.”

Children who still have deciduous teeth are the main goal of incisor (removal of pulp), whether they need it or not.

Unethical dentists will also perform shortcuts to the procedures covered by other methods for patients, and at the same time bill the insurance company in full-this practice is called “upgrading.”

For example, miniature implants can be easily encoded. Standard dental implants are artificial tooth roots installed by dentists to fix crowns or bridges. In contrast, micro-implants are like “pins compared to bolts,” said Dr. David Wayman, a dentist in Buffalo, New York. In the past, micro-implants were only used for fixed dentures, but because their installation speed is very fast, and the cost of dentists is 60% lower than ordinary implants, more dentists recommend them as long dentures. Long-term solution.

Weinman said: “Our dental community will see a high failure rate when using micro-implants where conventional implants are needed, but this has not stopped some dentists from pushing them to patients with more advanced conditions. “

Then there is a horrible story that the dentist has gone bad. In March, Massachusetts orthodontist Dr. Mouhab Rizkallah Indicted by the State Attorney General Deliberately making the patient’s braces longer than medically needed, and deceived the mouthguard. The complaint against him stated that he instructed his staff to buy plastic mouthguards at a discount store, even though he knew that plastic mouthguards could not fit the patient’s teeth properly. Then Rizkallah billed Medicaid for $75 to $85 higher than the retail price of each, and the mouthguard alone received $1 million in reimbursement. According to the lawsuit.

The performance of other dentists is much worse.After filming a video of Dr. Seth Lookhart, an Alaskan dentist, riding a skateboard during dental surgery Spread of the virusThe authorities that aroused great interest discovered that he had been sedating almost all patients in order to profit from the reimbursement paid by Medicaid general anesthesia.he is Sentenced to 12 years in prison last year In prison.

After discovering that she had used the same insurance premium to harm her patients through unnecessary general anesthesia, the Texas Dental Board revoked the license of Bethaniel Jefferson, a dentist practicing in Houston.she was Put a patient in a hypoxic state For such a long time, the child suffered severe brain damage.

Dr. Scott Charmoli, a Wisconsin dentist, was Accused of fraud After he was found to use his drill to intentionally break the patient’s teeth, he could bill the insurance company for crowns instead of fillings.This Indictment allegations He performed coronation procedures worth more than US$2 million between January 1, 2018 and August 7, 2019-more than 80 fraudulent coronation procedures per month.

Weinman said that patients can always seek a second opinion, especially for expensive treatments, and dentists who seem to hesitate when you say you want a second opinion are worrying. He said: “A dentist who is confident in his own abilities will have no problems when you check the diagnosis or treatment plan elsewhere.”

Other red flags: Weinman is wary of any dentist who appears to be reading the script, or who pushes the treatment plan too hard or refuses to explain the treatment plan. Weinman said: “There may be several scientific, evidence-based treatment options available to patients, and a good dentist is willing to explain your options, even those that may not be so profitable.”

---

Corning (Kaiser Health News) is a national newsroom that provides in-depth news on health issues.Together with policy analysis and polling, KHN is one of the following three main operational plans KFC (Caesar Family Foundation). KFF is a donated non-profit organization that provides information about health issues to the country.