{1 - 24} GreyGrey
{25 - 49} GreenGreen
{50 - 499} BlueBlue
{500 - 4999} OrangeOrange
{5000 - 24999} RedRed
{25000+} BlackBlack

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Fraud

I’ve worked for the same company for almost 3 years and as time goes on, I continue to see what they do is wrong.

For the last year or so when they bill out a partial/full denture they also charge an additional code of D5999 other maxiofacial code. They charge this out anywhere from $250-$1000 (1 per upper, 1 per lower, in addition to the denture/partial code)

They do this depending on the insurance PPO writeoffs. If the patient has good insurance, they charge more on the D5999 code but they do not submit that code to insurance. So the patient pays that portion and they tell them it’s a lab fee. Also we now charge $1995 per each partial or denture.

I have contacted a few insurances and left anonymous reports but nothing has changed so i don’t know if it’s become a case or not.

Another thing I’ve been noticing is from one of the same doctors that does this, is his upcoding ( not sure if that’s the correct term ) but this especially happens for our non insurance patients who have signed up for the in house dental membership (they get a 10-20% discount on services) I just had a patient who was treatment soft tissue impaction extraction. It was tooth #1 and it was erupted. Doesn’t the tooth have to be covered by gum tissue to be charge this code?

I don’t even know who to contact regarding this, but they are constantly taking advantage of their patients and they don’t know it.

What do I do?



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2 Answers

This is not a good situation! Beyond filing reports with insurance carriers, you can file a report with your state’s Board of Dentistry. I applaud you for looking out for these patients!

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I am interested to know what happened since july…?

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