The U.S. Attorney’s Office Eastern District of Wisconsin announced that on March 10, 2022, 61-year-old dentist Scott Charmoli was convicted of five counts of healthcare fraud and two counts of making false statements related to healthcare matters. The evidence presented at trial established that Scott Charmoli engaged in a years-long scheme to defraud dental insurance companies into paying for unnecessary crown procedures.
The evidence during trial showed that beginning in 2015, Charmoli started to aggressively sell patients on the need for crown procedures. After convincing patients they needed crowns, Charmoli intentionally broke his patients’ teeth with his drill and took pictures and x-rays of the damage he caused. Then, Charmoli sent images of the damage he caused to insurance companies as support for his requests for 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.
The evidence showed that Charmoli performed far more crowns than most dentists in Wisconsin, ranking in or above the 95th percentile of crowns performed in each year from 2016 to 2019, according to data from just one insurance company. The evidence also showed that Charmoli billed over $4.2 million for crown procedures between 2016 and 2019, and that he performed more than 700 crowns each year from 2015 to 2019. In both 2015 and 2016, Charmoli performed over 1,000 crown procedures. Evidence also showed that in addition to submitting x-rays to insurance companies of damage he caused, Charmoli made false statements to dental insurers when they denied initial claims for crown coverage. In 2019, Charmoli’s crown rate exceeded 32 per 100 patients.
Because crown procedures are rarely fully covered by insurance, Carmoli’s patients often had to pay co-payments out of pocket.
Former patient Todd Tedeschi testified that Charmoli convinced him he should get two crowns done at once so that he could avoid having to repeat anesthesia even though his teeth were not causing him any problems: “It seemed excessive, but I didn’t know any better. He was the professional. I just trusted him.”
Charmoli is scheduled to be sentenced on June 17, 2022 by United States District Court Judge Lynn Adelman. 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.
Charmoli’s healthcare fraud scheme was discovered after he sold the practice in 2019 and the new owners reviewed his files and realized that his rate of crown procedures was extraordinary high.
Charmoli has been named in dental malpractice lawsuits filed by almost 100 former patients. Those Wisconsin dental malpractice cases were stayed pending the outcome of the federal criminal prosecution.
If you or a loved one were injured as a result of dental malpractice in Wisconsin or in another U.S. state, you should promptly consult with a dental malpractice lawyer in Wisconsin or in your state who may investigate your dental malpractice claim for you and represent you or your loved one in a dental malpractice lawsuit, if appropriate.
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