Situation Report: Suspected Fraud

The Situation: A large insurance carrier received repeated complaints that a dentist was charging for services that were not performed.

The Challenge: To determine if these allegations were based in fact, and assist the lawyers in preparing their case.

Actions Taken: We performed a focused review of dental charts and compared the dentists treatment profile to that of the surrounding community.

The Results: Our report detailed numerous incidences of misused dental codes, services that were billed but not performed, and services that were allegedly performed hundreds of times more frequently by this dentist than expected for this population. The carrier received a significant out of court settlement.

Contact us for more information about fraud and abuse.

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