Dental insurance fraudi work for a dentist that bills out composite fillings to insurance companies but does sealants using flowable composite. She also recommended that a child under the age of ten needed seven root canals. I feel that she makes up work to be done as she goes. In addition, every medicaid/ state assistance patient that walks through our door magically needs fillings on every tooth. Im unable to find another position at this time and i dont want to continue to assist her while she commits these acts because it could come back on me as well. What are my options? Attorney answers (1)
Hello, in my opinion, you have two options: One is to do nothing and hope that this dentist never gets caught committing insurance fraud. You did not state what your position is, whether it is medical billing or a dental assistant, but If this dentist does get caught, you are correct in assuming that you could be held accountable as someone who assisted in the fraud. Your second option, and in my opinion is the better one, is to report your suspicions to the Fraud Department of the Delaware Insurance Commissioner's Office. Here is their contact information: Call 1-800-632-5154 toll-free in Delaware or (302) 674-7350; send an email to fraud@state.de.us; or mail a report to Fraud Prevention, 841 Silver Lake Blvd., Dover, DE 19904. If you are afraid of losing your job, you should be more afraid of being held accountable as someone who assisted in a fraudulent scheme. This could follow you for the rest of your career, especially if the matter becomes criminal.
Good luck!
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Other answers (1)
cerebellite
Answered by a user, almost 2 years ago.
I don't know if you will read this post, but I understand what you're going through. I've been through it. I know times are tough and jobs are still scarce, but you must do the right thing. If this dentist is overtreating and drilling into virgin teeth, she must be stopped. I would suggest writing a letter to the state dental board. Also, keep in mind that there are federal qui tam or whistleblower laws that protect you, if you do the right thing. Not that this should be the main incentive, but those laws also reward a 15-35% reward to the whistleblower on any monies collected by the government. Good luck
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