How Does Dental Embezzlement Affect the Patient?


Fraud is a huge problem in the United States. There are many types of fraud, but one of the worst for many people is medical or dental embezzlement. This is because it affects the patient in addition to insurance companies. Scarily, the National Healthcare Anti-Fraud Association (NHCAA) estimates that each year, tens of billions of dollars are lost as a result of health care fraud.

How Many Dentists Will See Fraudulent Activity in Their Offices?

Unfortunately, studies have shown that as many as three of five dentists will face some sort of fraudulent activity in their practices at some point in their careers. There is a scary statistic surrounding this issue that makes one wonder how many dental offices experience this in some form and are either unaware of what’s going on or are aware but won’t take action because of apprehension about what might happen as a result.

Who is Most Affected by Insurance Fraud?

Insurance fraud is a crime that can claim many victims. However, often, it is the patient who suffers the most. Essentially, the patient is also a victim twice. First, the individual has a problem of his or her insurance benefits being maximized. If the patient realizes something is wrong with the benefit entitlement of his or her insurance, the first thing they will do is blame the medical or dental office. Specifically, the blame may be placed on the dentist, even if the fraud is occurring from a different source within the office. The victim won’t know or care that it might be an employee working at the dental office who perpetrated fraudulent acts without the knowledge or consent of the dentist.

What are the Consequences of Dental Insurance Fraud?

In addition, the cost of health insurance, whether you receive it through your employer or purchase your own policy, increases the premiums when insurance fraud comes into play. This means that the patient has even greater out of pocket expenses. There is actually a twofold issue, however, as the benefits or coverage the patient receives in their insurance policies can be reduced. Sadly, when fraud is perpetrated, it has serious consequences. One of those can actually mean that some patients may no longer be able to have a much needed larger procedure done because the policy has hit its maximum pay out after a fraudulent act or worse, can afford their insurance at all when the premiums are raised.

Additional consequences can that can occur include employers no longer purchasing dental insurance benefits for their employees. This is a big problem because it is equally as important to get regular dental checkups and care every six months and as needed. Dental insurance is frequently the most expensive part of any group insurance benefits plan. If employers are dealing with financial stress as a result of dental embezzlement, it can have severe consequences, with the patient become a victim for a second time because they lose their benefits.

Dental fraud is a crime that affects everyone. It can result in devastation for people and companies directly involved but is even greater as it can lead to huge shakeups with prices skyrocketing and coverage being reduced or even eliminated. It is not worth the aftermath of pain and financial loss.