One of the primary tenets of the Hippocratic Oath is the promise to “do no harm.” Evidently a dentist outside of Milwaukee never got that memo. Recently a Wisconsin federal grand jury indicted Dr. Scott Charmoli and charged him with chipping healthy teeth of his patients simply so he could apply expensive crowns.
According to the indictment,
“Scott Charmoli knowingly and willfully executed and attempted to execute a scheme to defraud health care benefit programs… and to obtain, by means of false and fraudulent pretenses,… money and property owned by, and under the custody and control of such programs, in connection with the delivery of and payment for health care benefits, items, and services.
“Charmoli falsely advised patients they needed crowns for teeth that had four intact cusps or were, in other words, not broken. To deceive patients into believing they needed a crown, Charmoli would frequently take an x-ray of the tooth and show the patient a line or spot that he would tell the patient was a fracture or decay that necessitated the crown.
“Patients, who believed that Charmoli was the expert, accepted his false representations and agreed to the crown procedure. Upon beginning the procedure, Charmoli used his dental piece (known as a “drill”) to break off a portion… of the patient’s tooth.
“By breaking the patient’s tooth, Charmoli caused permanent disfigurement and serious bodily injury.
“After intentionally damaging the tooth… Charmoli took, or instructed his dental assistant to take, an intraoral photograph or x-ray… of the broken tooth. After documenting the damaged tooth, Charmoli completed the crown procedure and submitted… a claim for coverage to the insurance company.”
In just a year and a half, Charmoli submitted $2,076,039.00 in claims for crowns to various insurance companies. Depending on the insurance company and plan, often the full cost of the crown was not covered by insurance.
Who paid the balance? Local media sources say his patients.
If convicted, Charmoli faces 20 years in prison. Because he is 60 years old, Charmoli could die in prison if he receives the maximum sentence.
After his indictment, a Justice Department spokesperson in Milwaukee said, “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.”
Whistleblower Rewards for Healthcare Fraud
We don’t know how Charmoli was caught (or even if he is guilty). A federal magistrate has signed a protective order in this case designed to protect the privacy of Charmoli’s patients. Unfortunately, however, unless this case goes to trial, we may never know how he was caught.
Most healthcare fraud cases come to light because of the brave actions of whistleblowers. Often those folks are other healthcare workers. In this case we wouldn’t be surprised to learn that it was one of Charmoli’s dental assistants or billing clerks.
Many people wrongly believe that healthcare fraud is a victimless crime. As this case shows, however, it is often the patients that suffer.
Under the federal False Claims Act, whistleblowers who report healthcare fraud involving state or federal healthcare funds are entitled to cash rewards. Rewards range from 15% to 30% of whatever the government collects from the wrongdoers. The typical reward is 20%.
Because the law also provides for high fines and triple damages, big rewards are common.
To learn more, visit our healthcare fraud whistleblower reward page. Whistleblowers can remain anonymous while the case is being investigated and are entitled to powerful anti-retaliation remedies.
If you are ready to see if you qualify for a reward, contact us online, by email or by phone 800.669.7782. All inquiries are protected by the attorney – client privilege and kept confidential. We accept cases nationwide.
Mahany Law – Wisconsin Whistleblower Lawyers
(offices nationwide including Milwaukee Wisconsin)