Hello all. I am a former dental hygienist. I say former because I’ve been stay at home mother for about six years and my license to practice has expired, but I suppose once a hygienist, always a hygienist lol… Anyway, over the years I have worked at many different offices with different ethical standards.
There was one office in particular I quit working at due to their flagrant abuse of insurance filings. They constantly post dated claims, meaning, called patients in for cleanings earlier than their six month due date to fill the schedule, and “held” the claim to date it for a different day so it would be paid. When I told the office manager I wasn’t comfortable signing my name to the chart with dates that would later be changed she was shocked. She said, “oh I’m sure your other office [that I worked at part time as well] does this too!” No, absolutely not, it’s fraudulent and can end up in jail time and loss of licensure and insurance.
At any rate, fast forward to this month. I was at my own dentist for a consultation on some problems I have been having and the treatment plan for a special bite adjustment and mouth guard was $3500. I said, there is simply no way I can do this. The doctor’s wife is the office manager and she said, oh not to worry, I should pay what I could and she would bill the insurance for a little of this and a little of that until the balance was paid.
I didn’t answer to that because I was pretty shocked. Most dentists know perfectly well that mis billing on purpose is against the law, and can result in serious repercussions including not being allowed to file with them any longer, and having to reimburse previous claims etc. not to mention the federal crime aspect. Every claim has a line on it that says under penalty of federal law I swear that this information is true to the best of my knowledge.
So here is my problem- she didn’t DO this, since I declined treatment, she just suggested it. I keep track of my account and haven’t seen anything billed incorrectly. I really hate to get involved, but any office that is misappropriating insurance monies is of course costing us all. However, I feel as though I have this in my head and I am not telling the insurance company something they may need to know.
So, should I call united health care and tell them, or leave it alone? Any thoughts? Thank you.