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Healthcare Fraud in Dental is as Simple as Pulling Teeth

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Healthcare Fraud in Dental

We read a lot today about rogue providers like doctors, nurses, home health providers and others that concoct elaborate fraud schemes for personal gain. This dental fraud case takes it to a new level and involves identity theft and falsifying documents as a dentist.

September 22, 2017 was the sentencing day for Elena Ilizarov of Stamford, Connecticut for her role in an elaborate fraud scheme. Ms. Ilizarov served as an office manager for Advanced Dentistry, a dental practice. For over 11 years (2005-2016), she billed 37 private dental insurance companies for services allegedly performed by a dentist (actually an identity theft victim) for patients when in fact, the victim did not perform those services. Wait, what!?

The identity theft victim was an unknowing retired dentist who had previously been a dentist at Advanced Dentistry.  A total of $1.2M was billed through this fraudulent and identity theft scheme.

How did she do it for some many years?

Easy. She renewed the Dentists’ Connecticut dental license as well as his DEA prescriber’s license without his knowledge or consent. As a result, the insurance companies issued 1099 forms to the IRS (identity theft) pertaining to the retired dentist (she renewed his license and paid for it with her credit card). She also applied for and received liability insurance in his name.

Summary:

If someone is willing to go the extreme length of committing identity theft to perpretrate a fraud, insurance companies can be duped into making payments that seem legitimate. It is a good reminder to providers, whether currently active as a licensed caregiver or retired, to check their license status with the State License Board each year.

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