Dental Ethics

What Does Bad Ethics in a Dental Practice Look Like?

Is healthcare fraud always caused by a disgruntled employee? Surprisingly not. If the opportunity is seen, and the need is real, an entire group of people can rationalize that their fraud is somehow different than real fraud.  So what does bad ethics in a dental practice look like?

At the Anderson Dental Center, Anderson, Indiana, fraud was a group exercise; an area of expertise for the entire practice. Though the case goes back a couple of years, it shows how unethical behavior can infect the very soul of healthcare and of a medical or dental practice. It is important to say that the case was not brought about because of professional incompetency, but by greed.

The actual, registered owner of the practice was Sally Metzner. She should not have been, but we’ll get to that matter shortly. Sally and her co-defendants were all involved in inflating Medicaid claims and other schemes to get larger reimbursements. They went so far to not only inflate claims, but they would also forge documents with fake signatures to back up their phony claims.

As federal investigators began their probe it became apparent that not only did the charges expand but the people involved in the scheme widened. At the end of the investigation the charges would include the following: money laundering, corrupt business practices, forgery, Medicaid fraud, theft and practicing dentistry without a license.

While it is assumed that the owner of the dental practice initially cooked up the Medicaid scam, those roped-in included three dentists: Paul Pangallo, Jeffrey Rich and Thomas Dubois. Four office workers were charged, two of whom were also under suspicion of prescription drug fraud, and two were under suspicion of forgery. One of those charged was Jessica (Metzner) Worrell, the daughter of the owner. As the investigation continued to widen yet another office worker was charged with prescription drug fraud only.

A Virtual Scam Party

As the investigators reached back, they discovered that Metzner and her office cohorts started scamming Medicaid in 2006 and they were going strong almost to the end of 2011. They charged for services they didn’t provide, inflated claims for services rendered, submitted claims for work performed by dentists who weren’t authorized Medicaid providers.

In some cases, they had the audacity to submit claims on behalf of dentists who no longer worked at the clinic, and in other cases, they submitted claims for dental procedures when they lacked the equipment to perform those procedures.

The scam party was so ingrained, that even after the investigation started, the office continued to fraudulently bill. They were not at all phased by the possibility of consequences, especially Sally Metzner. Ms. Metzner was also given a cease and desist order by State Board of Dentistry because she was not a licensed dentist and wasn’t allowed to own a dental practice. The Medicaid provider status of dentists was suspended. They can no longer receive Medicaid compensation.

Where did the hundreds of thousands of dollars of Medicaid overpayments go? Essentially, the $300.000 that was stolen, lined the pockets of the dentists and the office workers. They shamelessly took the money and spent it on themselves and office decoration. In addition, Metzner failed to pay taxes on more than $850,000. The tax evasion was a separate case and she received penalties in that matter on a separate basis.

In 2014 Metzner was given a two-year sentence for tax evasion and eight years for Medicaid fraud. Four of those years will be probation. She sits in jail. Though the dentists are technically allowed to perform dentistry, as they can’t get paid through Medicaid, their ability to earn a living has been greatly curtailed. It will also be very hard for them to join another group practice. By the way, would you want to go to them for a dental treatment, when their name pops up on any internet search?

Consequences without Novocain

A total of nine people, pretty much the entire clinic, sold their integrity, sense of ethics, professional standing and their futures for a scam that netted them nothing. What was $30,000 (or much less) and change to a practicing dentist?

I am particularly bothered that a mother would drag her daughter into such a scheme. However, I am also upset that prescription drug fraud was another outcome, showing that unethical behavior often leads to the cultivation of other unethical behaviors. As she sits in jail, I wonder if it ever crosses Sally Metzner’s mind?

The entire practice also failed to realize that ultimately, the people who pay higher health and dental insurance premiums for their fraud is them.

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