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Medicine The Courts

Dentist Broke His Patients' Teeth To Make Millions Installing Crowns, Jury Finds (arstechnica.com) 103

Posted by msmash from the absolute-horror dept.
A dentist in Wisconsin has been found guilty of deliberately breaking his patients' teeth with a drill so he could collect millions of dollars to repair the damage with dental crowns. ArsTechnica reports: The alleged scheme by licensed Grafton dentist Scott Charmoli, 61, appears to have begun in 2015, when the number of crowns he installed abruptly increased. In 2015, Charmoli installed 1,036 crowns, well over the 434 crowns he did in 2014. Amid the royal boom, his income increased by more than a million dollars, going from $1.4 million in 2014 to $2.5 million in 2015, according to court documents. From 2016 to 2019, Charmoli billed insurers and patients over $4.2 million for crown procedures, according to federal prosecutors. Charmoli ranked at or above the 95th percentile for the number of crowns installed by dentists in the state in each of those years, the report added.
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Dentist Broke His Patients' Teeth To Make Millions Installing Crowns, Jury Finds More

Dentist Broke His Patients' Teeth To Make Millions Installing Crowns, Jury Finds

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  • ..where not having insurance has its advantages. Nope, sorry Dr. Scumbag, you're not going to injure me and make bank, I don't have insurance!

    • Wow, what awful choices to have to make.

    • You're assuming an oddly high level of morality to someone who literally broke people's teeth so he could charge to repair them. Do you honestly think he wouldn't have done that to an uninsured patient and billed them for it?

    • Re: (Score:2)

      by q_e_t ( 5104099 )

      Nope, sorry Dr. Scumbag, you're not going to injure me and make bank, I don't have insurance!

      So he's going to injure you and then you are going to suffer just to spite him?

      • Not understanding (or really, caring about) the American system, is there something to prevent the injured patient from taking their damaged teeth to a different dentist for a second opinion?

        Let me guess - was that how he was caught? Going on recent contact with arstechnica, it's not worth going to, hoping to get questions answered.

        • Re: (Score:2)

          by q_e_t ( 5104099 )

          Not understanding (or really, caring about) the American system, is there something to prevent the injured patient from taking their damaged teeth to a different dentist for a second opinion?

          If they are 'in network' it'd be an option. My previous comment was supposed to be humorous, though.

    • Re: (Score:2)

      by DarkOx ( 621550 )

      Yet one of the things that is going to put this guy away is insurance company statistics on how often these procedures are really required.

      It looks like the guy who bought the practice actually tipped off the prosecutors office after he started reviewing patient records and said 'WTF'. Its actually kind of disappointing and a little worrisome that the insurers did flag this themselves. They really should be monitoring providers in their network (for their own financial interest as well as protecting patien

      • Re: (Score:2)

        by jbengt ( 874751 )

        Now of course it may be for example that one DMD or DDS is the 'crown wizard' in the area and other dentists refer patients to him to try and save marginal teeth that might otherwise need to be replaced with an implant.

        I have an experience that confirms both the view that unnecessary dental procedures are common moneymakers and that some dentists are more proficient and prolific in certain practices.

        I went to a local dentist who wanted to me to make another appointment for a bunch of fillings and also re

        • Re: (Score:2)

          by PCM2 ( 4486 )

          I have an experience that confirms both the view that unnecessary dental procedures are common moneymakers and that some dentists are more proficient and prolific in certain practices.

          I've seen it with doctors. I've had one who wanted to "figure out the right dosage of a prescription," which meant going back for office visit after office visit, all within a couple of weeks. The same doctor told patients that it would be a HIPAA violation to disclose the results of lab tests over the phone. They'd need to schedule another office visit just to find out if everything seemed fine. (But of course it wouldn't -- that's another office visit.) And another doctor at the same office would just rat

    • Re: (Score:2)

      by PCM2 ( 4486 )

      ..where not having insurance has its advantages. Nope, sorry Dr. Scumbag, you're not going to injure me and make bank, I don't have insurance!

      Er, how does that work, exactly? I'll tell you what happened to me: I had a dentist tell me he wanted to replace an old filling and that it would cost me about $130. I didn't have dental insurance but I said that would be fine. An hour later I needed a root canal and a crown.

  • You want to think dentists and other medical professionals you deal with are honest and competent. The good thing is that the guy who bought the practice reported the bad behavior.

    • they really need to be part of medicare!

      • Re: (Score:2)

        by Klaxton ( 609696 )

        Democrats tried to put that into place recently, blocked by the party of shameless corporate shills.

      • Well, this is a different topic.
        Yet, health providers still get paid for procedures.
        And, being part of medicare will not prevent this type of incident.
        In fact, it may even exacerbate occurrances, since medicare likely pays less that the capitalistic rates.
    • You can make a pretty good living as a dentist being honest and competent!
    • Note that he ranked "at or above the 95th percentile for the number of crowns installed by dentists in the state in each of those years," meaning that there was still another 5% of dentists installing more crowns than he was. Is someone investigating them?

      • Re: (Score:2)

        by Klaxton ( 609696 )

        Good point, I hadn't thought about that!

        Crowns are hugely expensive in the US, and I'm suspecting a lot of it is pure profit. So the incentive to declare that the whole upper part of a tooth is unrepairable is pretty strong. Meanwhile you can take a trip just across the border to Mexico and get crowns and any other dental work done in state-of-the-art clinics for a fraction of the price.

        I went to a dentist for a checkup/cleaning one time and he claimed I had nine cavities that need to be filled. It didn't s

  • Hedge funds are buying dental practices based on a multiple of total dental practice revenue.

    https://medium.com/@aimunm83/t... [medium.com]

    Similar things are going on for kidney dialysis clinics and other regular medical businesses.

    Buy 5 dental practices, take low income patients (children) on medicaid / state aid - sell lots of unnecessary dental procedures, sell out to an investor for a multiple of sales - then retire rich.

    • or Google "Dental roll up practices"

    • I did some work for a company that was a vendor to a kidney specialist practice like this.

      I don't think they were intentionally scummy like that, but all of their offices were located near lower income and elderly populations and I think their model was definitely focused on Medicare/Medicaid patients, not typical patients with insurance. Although some of this could have been some kind of selection bias, as I suspect that kidney problems are more common in elderly and low income people (age and poor diet).

      • Re: (Score:2)

        by jbengt ( 874751 )
        There are definitely issues working on Medicaid patients, they tend to skip follow-ups, and Medicaid has somewhat arbitrary rules about billing, like only so many of certain procedures on a patient per year. This is upsetting to a new dentist I know, since the practice wants her to fudge billing codes because Medicare won't pay for the treatment that the patient actually needs.
  • In the US, I completely understand the need for medial insurance, because one trip to the hospital, depending on the circumstances can potentially bankrupt someone (cancer, organ transplant, etc, etc.).

    But dentistry? I could have all my teeth knocked out tomorrow and it would never approach the expense of a serious heath issue.
    • Get real expensive real fast if you don't have insurance. And probably shouldn't be that way but it is. So instead of having our government just pay for medical care what we do is have private companies doing it. The problem is those private companies nickel and dime the dentists and anyone who doesn't have insurance often becomes a charity case. The people who do have insurance often don't pay their co-pays just going from one dentist to another. This means we all have to pay more because the system disinc

      • Re: (Score:2)

        by narcc ( 412956 )

        Dental work doesn't need to be expensive.

        Some years ago, I broke a filling. I went to Aspen Dental, thinking that a big chain was a safe bet. 3 appointments and almost $2k later, my tooth was still broken. At the fourth appointment, I asked if they were going to fix my tooth that day. When they didn't answer in the affirmative, I told them to fuck off and went to a local dentist with a good reputation, but who was rumored to be 'expensive'.

        That guy had my tooth fixed that same day, for about $30

        • If you want really cheap dental work done, get it done in China. These are guys who do dozens of procedures every day and are so practiced in it they can do it in their sleep in about the time it takes just to book the appointment in most western countries. The work is really good quality, and the cost is so low you'll be asking them whether they've mis-calculated it, or whether they've just charged for a first instalment.
          • Don't go to China, go to Taiwan.

            • Re: (Score:2)

              by PCM2 ( 4486 )

              Friend of mine did it in Thailand. And his teeth were BUSTED up, from stuff like riding dirt bikes and playing hockey. He got the work done for a third of the price and the side effect was about 3-4 vacations to Thailand.

        • Re: (Score:2)

          by etash ( 1907284 )
          in greece that'd cost about 50-60 Euros max.

      • So if you can't afford dental Care you really will eventually just find a way to get it done and not pay for it.

        Worth pointing out here about how good NHS dentistry is (assuming you can get registered with one*). A few years ago I had trouble with a wisdom tooth that was impacted, then infected, then finally cracked in half (I actually heard it happen more than felt it). Called the dentist and was able to get an emergency appointment the same day. Treatment included: first consultation with an x-ray, two week course of antibiotics to clear the infection, second visit to remove the tooth and third visit to check on pr

        • Re: (Score:2)

          by PCM2 ( 4486 )

          This is probably because the NHS isn't generally concerned with cosmetic work if the taxpayer has to foot the bill.

          Dental insurance in the U.S. usually doesn't cover cosmetic work. So that's not generally what's driving up the price of dentistry here. It's a different scam. You're pressured into cosmetic procedures because the dentists know (and maybe the patients don't) that the patient must pay whatever they're billed.

      • If all you need are regular cleanings, you come out slightly ahead without insurance. However, if you need anything else, it starts adding up fast. I went about ten years without dental insurance and I think I was ahead in all but one year, during which I needed a tooth capped. It really felt like a gamble, though. Something like a root canal can set you back a couple thousand dollars. While that won't break the bank, the insurance was only marginally more expensive than cleanings and cleanings were co

      • But the insurance is useless. $50 a month, $600 a year. Two cleanings with X rays is $500 per year. Then when you do need a crown you find out there is a $1000 per year limit on the dental insurance pay out. So the only time you come out ahead is when need one and only filling besides the two cleanings. For that year you would pay the $600 for the insurance instead of the $800 for two cleanings and a filling.

        • I saw the benefits weren't great with the limitations. The numbers worked out this year to pick it up since I needed an expensive x-ray I've been putting off. I also wasn't sure if I'd need a root canal on my capped tooth, but its settled down. I'll have to decide whether its worth it next year.

        • Re: (Score:2)

          by PCM2 ( 4486 )

          But the insurance is useless.

          The insurance model itself doesn't seem to work for dentistry. Health insurance works because healthy people pay even though they never need procedures. By the time they start aging and getting sick, they've already paid into the system. Dentistry, on the other hand, tells everyone, young and old, that they need two cleanings a year and as many procedures as the dentist tells them they need. Insurance companies don't want to pay for all that.

        • Re: (Score:2)

          by AvitarX ( 172628 )

          It's pretax money though.

          So if you're at the 22% marginal tax rate, 600*.78 is less than 500.

          If you're at the 12% marginal tax rate, you're not quite there, but it's really close.

    • I could have all my teeth knocked out tomorrow and it would never approach the expense of a serious heath issue.

      I see you've never had your teeth knocked out. You know countries offer medical tourism to cover the cost of western dental care in extremes.

      Sure a teeth clean may run in at $40, but a single crown nears a thousand, and dental implants typically run into multiple thousands, and multiple consecutive dental implants often require an anesthetist present as well.

      One of my friend's parents didn't have dental insurance and wanted to get dental implants throughout most of his lower jaw. He flew to Bali, stayed a f

      • One thing I noticed is that they have a cap on the total they'll pay out unless you've got the most expensive plan. The break-even point on basic plans seems to be a cleaning plus some light work, like a filling or two. You come out ahead with the insurance if you need a root canal or anything major, as it pays about half the cost. If you need enough work that you go over the cap (which wasn't that high), you're still better off flying to Bali.

    • Dental cost may not approach the cost a more serious health issue like cancer. But it can very well be out of reach for someone even with "good" health/dental insurance like I had.

      I needed a crown and a little dental work done (just a few small fillings) to prevent further problems later on. Twenty years prior, I had more extensive dental work done (two teeth rebuilt after a hockey injury and a few fillings). The cost was pretty reasonable. I was single and could afford it despite my college loans. I think

    • Dental insurance in the US isn't really insurance, because most of them have *maximum* payout. So they don't fulfill the one actual purpose of insurance, which is to hedge against (hopefully) rare but large bills. Once you realize that the label is incorrect and treat it as the prepaid-discount club that it is, it's much easier to understand.

  • Orin Scrivello

  • since they would have nothing to gain. Thank fuck i live in a country with a social safety net.

    • I live in a country with such a safety net, yet we have a similar case this year. The guy bought Ferraris and real estate with State money, while crippling his patients for years before the Social Security finally figured out something fishy was going on. (source [lefigaro.fr])

    • Of course they would. People are people.
      If a school gets more money for children diagnosed with ADHD... magically more kids get diagnosed.
      If a hospital gets more money if people are diagnosed with a certain disease... suddenly more people get diagnosed with it.
      If a particular crime brings in more money for public prisons, suddenly the prison guard union is against that crime being legalized.

      Do you think think prison guard unions or police unions are really morally against legalization marijuana? Of course n

  • Please tell me they're investigating every dentist who did more crowns than this joker. I lived my whole life without getting any fillings until I moved and got a new dentist and all of a sudden I needed 8 fillings. The crazy bitch invoked the power of Christ when I told her the novocaine hadn't fully kicked in yet.

  • Dentists Lionel Guedj and his father Carnot Guedj are right now trialled for aggravated battery in Marseilles, France with 322 former patients joining a class action. The dentists voluntarily botched surgeries so the patients would come back frequently. They settled in a poor neighborhood where residents had freecare.

    Patients reported: prostheses on minors (stupid since children will still grow), a case of 24 teeth devitalized in a single day, losing/quitting jobs due to bad teeth/bad breath, military stopp

  • So, 1061 case of felony assault (Score:3)

    by joe_frisch ( 1366229 ) on Thursday March 17, 2022 @10:04PM (#62367787)
    Sentences to be served consecutively.

    As one of the unlucky ones where Novocain doesn't work well on me, the idea of unnecessary dental work goes far beyond the cost issue.

    Medical personnel need the public trust, and when they betray that, that needs to be considered in sentencing. This should NOT be settled with a lawsuit but with real prison time.

    • perhaps try nitrous as at least some dentists offer that as an alternative

      really though, try to stave it off as long as you can with flossing + sonicare + good herbal rinses (e.g., https://www.amazon.com/Dental-... [amazon.com])

      • Thats what I'm going to try next, just need to find a dentist near by. If that doesn't work, I know of a specialist clinic near by that will perform all work while under general anesthetic.

      • Re: (Score:2)

        by PCM2 ( 4486 )

        perhaps try nitrous as at least some dentists offer that as an alternative

        Nitrous isn't an alternative. It's usually only offered because a lot of patients are afraid of getting needles put in their mouths. With the nitrous, they still get the needles but they don't freak out. I wouldn't count on nitrous numbing you enough for any serious procedure.

    • You're not the only one. I've got a condition that results in all local anesthetics only working on soft tissue. They don't work on bone, cartilage, teeth, etc. I finally figured it out on my last dentist trip (new Dr.) when after 4 different types of anesthetic, in 7 injections, I could still feel the slightest touch on my tooth. I finally figured out why I hated going to the dentist.
      • Nerve fibres aren't "soft tissue"?

        The last time I had a dentist stick the needle in me, it was centimetres from the site of work, to paralyze the nerve leading to the tooth. If that doesn't work on you, then a career looms as a travelling model for dental students to go "that's weird", "move over", "let me see!" above you.

        Somehow I suspect your dentist failed, comprehensively, to explain your condition.

        (I remember a dental visit when I was about 13. All 4 wisdom teeth to come out, prophylactically. They

  • A friend working as dentist said to me that when the dentist needs cash he was ÂÂfinding teeth to repair that were perfectly fineâ¦
  • would detect the abrupt change in pattern?

  • Charmoli ranked at or above the 95th percentile for the number of crowns installed by dentists in the state in each of those years, the report added.

    Well, each year 5% of the dentists rank in 95th percentile. That's what the 95th percentile means. I hope that's not the entirely of the case against him. I hope they actually show the he did deliberately break his patients' teeth. He is 61. What if his eye-hand coordination simply started to slip a little. If I was on the jury and these were the only facts presented to me, I'd laugh at the prosecution. I wouldn't even wait for the deliberations. I'd laugh right in court. Maybe they have evidence f

    • No. He's going to jail for his abrupt change in patterns. If you're a dentist working at a medical clinic that specialises exclusively in crowns that doesn't mean you're a fraud. But if you don't do a lot of crowns, and suddenly you do, chances are you may get investigated as to why your patterns change. You may have an excuse, or you may not.

      What if his eye-hand coordination simply started to slip a little.

      Then he'd find himself on the receiving end of medical malpractice for injuring patients. But funny you should say that, I had a dentist fuck up a crown after I knocke

    • Re: (Score:2)

      by tragedy ( 27079 )

      It seems like they must have expert witnesses who can confirm a pattern of drill caused damage in the patient's teeth.

  • "As medical professionals, we take an oath to 'do no harm' to our patients, which is why I felt the ethical obligation to report activity that I believed to be suspicious,"

    He should have done just like google, and have left out that pesky phrase from his oath :-)

  • This is just capitalist enterprise at work developing innovative new business models.
    • It's hardly new!

    • Re: (Score:1)

      by ebvwfbw ( 864834 )

      This is just capitalist enterprise at work developing innovative new business models.

      Don't confuse capitalism with criminal behavior. This has nothing to do with capitalism.
      Keep in mind, in a communist society they still have criminals. No matter what kind of government you have, you'll still have criminals.
      Someone lied to you and put that silly idea into your head. Communism is criminal. Snuffs the life out of millions and has killed millions.

  • Private pay-per-treatment is deeply and fundamentally immoral. It creates all sorts of perverse incentives which are applied to people who are in no condition to "shop around". It's disgusting that it is allowed anywhere; it is beyond disgusting that American companies keep trying to export it to the rest of the world.

  • I hear this a lot, especially about dentists. It's easy to f*ck up teeth and repair them again. Cheap money. Healthcare in Germany is mostly free, but you have to be on your toes about surgeons eager to book an operation even when it's not neccessary, because it's easy cash via German public healthcare. Some doctors are notably cold-hearted a**holes in that regard.

  • Free market capitalism + healthcare = A great model that all developed countries should follow. Patients get an abundance of healthcare. Fantastic!
    • In single-payer systems, similar frauds exist. The only way to solve that is for the doctors' pay not to be based on the number of procedures performed.

      • Isn't that how Canada 'fixed' the problem of high doctor pay?

      • Who said anything about 'single payer'? The problem is providing medical care based on profit rather than on patient health outcomes. It isn't fraud, it's just f**ked up priorities. This dentist story is simply an extreme example. How many unnecessary procedures & treatments do you think go under the regulators' radar?
      • No, all medical professionals work for the goverment.

        I had my wisdom teeth removed by a Navy dentist during the final month of my training. They get paid by the month just like all the other officers, no incentive to do extra work.

        My wife is a home care nurse. She went to nursing school on a state scholarship and tends children on Medicaid. However she has to be employed by a private staffing agency that takes a large cut to do the paper work. Just eliminate that and go full goverment run.

  • President Obama promised to protect us from doctors that mis-treated diabetic patients to 'make bank' on amputations? [youtube.com]

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