Law And Ethics : Dental Fraud For Profit

Not only did the dentist have possible legal violations, but there is evident failure to follow ethical principles. One of the applications of the

While most of the patients I interacted with were seeking non-dental care, I met patients who were seeking care to health conditions that stem from their oral health such as oral abscesses, which our team was unable to treat except for prescribing antibiotics or painkillers. I encountered similar situations when I shadowed physicians in the emergency room of hospitals, observing a variety of craniofacial disorders originating from a preventable tooth decay. From these observations, I learned that patients often did not receive treatment that addressed the root of their problems: their oral health. As the result, I learned that many physicians saw the same patient repeatedly for problems that would otherwise be easily prevented through proper preventive dental care. Determining to address the unmet needs for accessible preventive dental care, I decided to pursue a career in dentistry so that I can provide a positive and meaningful impact to the underserved community on their oral health and ultimately their overall

When providers or patients submit false or misleading information intentionally to a health plan, this is fraud. Some examples of healthcare fraud and abuse include filing claims for services or medications not actually performed or obtained, billing for services for non-covered items using codes for billable services or items, altering medical records, waiving co-pays and deductibles, up coding and unbundling, using someone’s insurance card, billing Medicare patients at a higher fee than non-Medicare patients, and accepting kickbacks for referring patients, to name just a few. Fraud can be committed by hospitals, medical providers, laboratories, pharmacists, billing services, medical equipment suppliers, and even patients. Patients can protect themselves from healthcare fraud and abuse by knowing their healthcare benefits, reviewing the explanation of benefits, asking the doctor to explain the service that was given, report discrepancies, protect insurance cards and member identification numbers, beware of free services, report copayment and deductibles being waived, and never sign blank insurance forms.

“Too many times we see special needs patients who have been held down, papoosed and head-boarded while receiving brief treatment at other offices. While we understand that the care of these individuals can be challenging, they shouldn’t be shortchanged by a quick cleaning, no x-rays or an extraction instead of saving a tooth because that office can’t stabilize the individual in a comfortable and humane fashion.” (Dr.Kaminski) Patients with disabilities and special needs deserve the same kind of dental care as a patient who does not. Special needs patients require more care and attention than patients that do not have special needs or disabilities. Patients with medical conditions that

Health care has been an issue for the United States of America for multiple years. Dental care, a topic that does not get much attention because people believe it is trivial, plays a major part in people’s lives, particularly children. Gerard van Honthorst’s The Tooth Puller shows a dentist pulling a patient’s tooth with five observers watching. Van Honthorst shows how in awe or scared people are of the dentist. There is a negative outlook on dentists and dental care: people are afraid of the dentist giving them their negative connotation, while dental care only causes pain in many people eyes. There is a problem in the health care system and improvement in the system is needed because health care is a right for every citizen, especially dental care. The United States of America’s government should allow dental therapist to conduct the procedure that normal dentist conduct for free for children under the age of twelve. The government should fund the teaching, training, and employment of dental therapists to care for underserved people.

Perhaps the finest total dollar quantity of fraud is devoted via the medical health insurance companies themselves. There are severa research and articles detailing examples of insurance companies deliberately not paying claims and deleting them from their structures,[21] denying and cancelling coverage, and the blatant underpayment to hospitals and physicians beneath what are normal costs for care they provide.[22] Although tough to acquire the records, this fraud via coverage agencies may be anticipated through comparing revenues from premium bills and prices on health

Oral health care is an integral part of the US healthcare system. In 2012, Sen. Bernie Sanders introduced “The Comprehensive Dental Reform Act”, which aimed on expanding dental coverage, accessible oral health care centers, increase in dental workforce, enhanced dental education and encourage dental research. (Congress.gov). The ACA, aim to curb the national health spending, by facilitating the affordability to quality care through private and public health insurance. The purpose of this bill is to cut the healthcare costs and to reverse the “silent epidemic” of dental health status (surgeon gen). This dental bill with an integrated approach towards the preventive and comprehensive oral healthcare is estimated to provide coverage to almost 17.7 million adults. (ADA

Health insurance fraud is what drives up health insurance premium costs, wastes taxpayer’s money, but can also endanger beneficiaries or leave them uninsurable. In 2015, Medicare Strike Force reported over $700 million in false billing by doctors, nurses, other licenses medical professionals, laboratories, and individuals (FBI.gov). This is a staggering figure that is only getting worse. In this fictitious federal case I will be describing the criminal offender, the crime that was committed, the charge handed down by law enforcement, and the judicial process from the beginning of the criminal case to the sentencing of Dr. Richard Heartman, an internal medicine physician.

As the Chief Nursing Officer of the state’s largest Obstetric Health Care Center, this author is responsible for complaints regarding fraudulent behavior in the center. The purpose of this report is to (1) evaluate how the Healthcare Qui tam affects health care organizations, (2) provide four examples of Qui Tam cases that exist in a variety of health care organizations, (3) devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals, (4) recommend a corporate integrity program that will

Prompted by another practitioner, the government intervened in the case of Dr. John Roger Lund, a Saratoga, Calif. dentist who was arrested June 6, 2016 for performing unnecessary procedures on his patients and bilking insurance companies out of hundreds of thousands of dollars (Dentist). The 28 counts of felony insurance fraud included factitious charges and superfluous procedures done on patients with healthy gums and teeth. One individual had 18 root canal procedures completed by Lund during a five-year period, which is considered to be overly aggressive treatment. Due to patients’ lack of awareness, Lund and many other practitioners are able to manipulate the modern, insurance-driven, healthcare system and operate with a sense

A huge problem many people run into with a dental insurance plan is that after a certain amount of dental work is done, the insurance company simply stops covering your needed dental work. At that point, you have to pay out of your own pocket or upgrade to a more expensive insurance plan.

Anyone in the medical field may seem trustworthy because most of the time they are. Unfortunately, there are those individuals who seek financial gain and are no longer trustworthy. There is no exact amount of how much fraud has been committed within the health care system, because it usually is never detected. Like in the case of Dr. Guerrero who committed a healthcare fraud scheme against his patients, employees of the health care system, and health care insurances. According to Vivek Pande and Will Maas, Dr. Guerrero was able to commit fraud against clients and the health care system and insurance providers; it is an ingenious crime, because the public considers them intelligent and high achieving individuals. (Pande & Maas, 2013) Overall, health care providers have a choice

Billing for services not rendered, or medications charged to insurance companies but clearly not given is evident. Since the patients Nicole cares for are children and adolescents, they are not able to fully protect themselves due to lack of maturity or knowledge on the subject. Being aware of this vulnerability, Nicole preyed on these victims with the certainty that these patients would have no idea. Health care fraud “displays a reckless indifference to the safety of the American people and constitutes a clear abuse of the public trust, showing a blatant disregard for systems and laws designed to protect public health (p. 210).” These children and families placed their trust in Nicole, who had a duty to care for them, and this duty was undoubtedly

As we become prepared to work in a medical office field,we have to keep in mind so many fraud and unworthy act of health insurance claims out there. Everyday we see on the news how people be under investigation for fraud,and mostly the doctors,physicians know the rules but yet still do wrong. I think as we get prepared to work out there in this field, we should be very careful, and if we witness a fraud about to be happened, we should report it. It is not fair for others to be over billed or whatever the cause might be. Many fraud cases include stealing patients identities. Since its actually our job to actually ask them for personal information.Some examples of fraud are: Home health visits, they are more hard to prove or dissaprove in court.Over

After looking at various articles on the Dentaltown website, I came across an interesting article that showed an unethical dilemma. In this article, a dentist (lower-priced dentist) is talking about an 83-year-old patient that came into his office for a second opinion. The lower priced dentist mentions that the woman needed some basic dental work done to her teeth to keep them healthy. While (deleted comma) the woman was at her general dentist, the dentist was attempting to force the woman to get a more expensive cosmetic work done. Her general dentist provided her with an expensive treatment plan for approximately $14,700. Upon hearing the cost, the patient went for a second opinion from another dentist in town. After looking at her x-rays, she was given another inexpensive treatment option using composite now and later putting in crowns if needed. The patient got her work done with the inexpensive treatment and goes back to her regular dentist for a routine check-up. She told her regular dentist about the bonding work done instead of the crowns. At hearing this, he replied that he could have done that for her as well.