If It Ain’t Broke, Don’t Fix It

One of the most egregious forms of fraud under the False Claims Act is not just billing for services and procedures that were never provided, but actually performing unnecessary services on patients. This type of fraud is especially hard to detect at dental offices, as dentists drill under the enamel and patients often don’t understand what procedures were performed. The recent prosecution of disgraced dentist Scott Charmoli serves as a case in point: Dr. Charmoli’s patients’ teeth were fine; however, teeth in good shape doesn’t equal good billing for unscrupulous dentists.

Charmoli, who operated Jackson Family Dentistry in Jackson, Wisconsin., broke his patients’ teeth by drilling into them purely to  charge them, and the government, for fixing the harm he’d caused.

In 2014, Charmoli earned $1.4 million from placing 434 crowns; that number rose to $2.5 million from more than 1,000 crowns the following year.  One of the clues about the healthcare fraud was that Charmoli placed more crowns than 95% of Wisconsin dentists from 2016 to 2019. During Charmoli’s criminal trial, it came out a typical dentist in the state performs around six crowns per 100 patients, while Charmoli performed more than 32 crowns per 100 patients – almost a third of his patients.

In December 2020, Charmoli’s lawyer commented that the only thing her client was guilty of is hard work — ostensibly a reference to how hard it is to drill through good enamel. In fairness to his counsel, oftentimes criminal defense attorneys don’t ask and don’t know the extent of their client’s conduct.

At trial, the jury determined that Charmoli deliberately harmed his patient’s teeth, and then submitted falsified pictures and x-rays reports to the insurance company to justify the procedures. Charmoli was convicted of healthcare fraud on July 18^th, 2022, and sentenced to 54 months in prison and a million dollars in restitution – so crime does not pay.

The Journal Sentinel revealed that Charmoli has been sued by around 100 patients because of this clinical misbehavior. Those lawsuits were paused while the criminal trial was ongoing and now presumably the Defendant will eventually declare bankruptcy and his malpractice insurance carrier may disclaim all coverage because the acts were intentional, not just negligence.

This is just one example in the health care space of egregious behavior for the sake of the profits, not for the patient. If you’re aware of a health care practitioner billing for unnecessary services you should report this to a whistleblower law firm in a timely manner, and as a result you can potentially receive a whistleblower award for doing the right thing, and more importantly, preserving the sanctity of protecting the patient. In this case, the jury understood that this conduct was criminal – a dentist drilling as far as hitting the tooth pulp to gin up billing for billing’s sake. In one sense, this is just a bad version of Pulp Fiction that a conscientious insider could have put a stop to using the False Claims Act.