Contacting Insurance Provider
At this point I would assume you have already contacted your insurance provider to dispute charges, and they have come back and said they are valid charges from your dentist. If you are an unlucky one like my roommate, the dentist has probably already sent you to collections, and now you are disputing charges with a collections agency or the credit bureaus.
This time instead of calling your insurance provider to dispute charges, request to speak to a member of their fraud department to make a formal complaint and have them begin an investigation for fraud by one of their providers.
Below is a list of some insurance contacts for reporting fraud waste / abuse. If your insurance provider is not on the list you can easily find them by going to google and searching for: Insurance company report fraud
Patient Rights
I feel a lot of patients do not understand their rights, or the resources at their fingertips. Every doctor should follow certain ethics and code of conduct to be licensed in the state of California. Doctor’s face the risks of both Criminal and Civil court proceedings.
The easiest way to start a criminal investigation, is to contact your local police department and request to speak to an investigator/detective to open a case on a local dentist and give them your details.
After contacting your local police department the next steps would be to report them to the various state dental medical boards as well as government agencies that handle consumer complaints.
One dentist that I was researching, had multiple complaints filed against them in the state of Nevada before moving to California. After the Nevada dental state board conducted their research, they found that the dentist was in the wrong and was required to pay restitution to all the patients that where in the suit. The dentist was required to pay back to the patients fees that were charged for un-needed services as well as remove fee’s the dentist said was owed collections on.
Dental Management Company Benevis and Its Affiliated Kool Smiles Dental Clinics to Pay $23.9 Million to Settle False Claims Act Allegations Relating to Medically Unnecessary Pediatric Dental Services
https://www.justice.gov/opa/pr/dental-management-company-benevis-and-its-affiliated-kool-smiles-dental-clinics-pay-239
Filing false claims may result in fines of up to three times the programs’ loss plus $11,000 per claim filed. Under the civil FCA, each instance of an item or a service billed to Medicare or Medicaid counts as a claim, so fines can add up quickly.
https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/