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A Wisconsin Dentist Broke His Patients’ Teeth, Charged Them For Fixing The Damage, And Collecting Insurance. He Was Just Convicted.

As if people needed another reason to fear going to the dentist.

Scott Charmoli, 61, was convicted of “five counts of healthcare fraud and two counts of making false statements related to healthcare matters,” the U.S. Attorney’s Office for the Eastern District of Wisconsin announced on March 11. The announcement explained that Charmoli “engaged in a years-long scheme to defraud dental insurance companies into paying for unnecessary crown procedures.”

Charmoli was found not guilty on two fraud counts relating to two teeth of a patient the dentist worked on. A third tooth Charmoli worked on for the same patient helped get him a guilty verdict.

The fraud began in 2015, when Charmoli began to “aggressively sell patients on the need for crown procedures.” Charmoli would first convince his patients that they needed crowns and then break their teeth with his drill before taking pictures and x-rays of the damage he caused. Charmoli then sent pictures of that damage to insurance companies to receive payment for the crown procedures.

“Insurance companies assumed that those images of damage represented the pre-operative condition of the teeth, and as a result, paid the claims. Many of Charmoli’s patients also paid significant co-pays for these crown procedures,” the U.S. Attorney’s office explained.

Charmoli’s fraud put him in the 95th percentile of crowns performed in Wisconsin every year between 2016 and 2019, meaning he performed far more crown procedures than most other dentists in the state. During this time, he billed insurance companies for more than $4.2 million for crown procedures and performed more than 700 each year between 2015 and 2019. In 2015 and 2016 alone, he performed more than 100 crown procedures each year.

The Milwaukee Journal Sentinel reported that Charmoli “attached more than 1,600 crowns over a 20-month period.”

“An executive with an insurance company testified that, on average, Wisconsin dentists installed fewer than six crowns per 100 patients, but that in 2019, Charmoli’s rate exceeded 32 per 100 patients,” the outlet added.

Evidence at trial also showed that Charmoli made false statements to dental insurers if initially denied claims for crown coverage.

Charmoli was indicted in December 2020. At the time, People reported that “Charmoli allegedly performed more than $2 million worth of crown procedures between January 1, 2018, and August 7, 2019 alone.”

“The Justice Department focuses on prosecuting health care fraud not only to protect health care funds but also to protect patients who entrust their well being to providers,” U.S. Attorney Krueger said in an announcement about Charmoli’s indictment two years ago.

Charmoli, of Grafton, Wisconsin, is scheduled to be sentenced on June 17, 2022, the U.S. Attorney’s Office said in its press release. “Charmoli faces a maximum term of ten years of imprisonment for each healthcare fraud conviction and a maximum term of five years of imprisonment for each false statement conviction,” it added. It is likely Charmoli will get a lighter sentence than the maximum.

Chamoli also faces medical malpractice lawsuits in Washington County from nearly 100 former patients, the Journal Sentinel reported.

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