Dentist accused of health care fraud sentenced to 4 1/2 years – InsuranceNewsNet

MILWAUKEEGrafton resident and Jackson dentist Scott Charmoli was sentenced Friday for billing patients and their insurance companies for $4 million in what federal prosecutors said was fraud.

U.S. District Court Judge Lynn Adelman sentenced Charmoli to 54 months in prison, followed by three years of supervised release. Restitution will be determined in the next 90 days.

He was also ordered to forefeit more than $1.04 million. Charmoli was convicted in federal court in March on five counts of health care fraud and two counts of making false statements related to health care matters.

Federal officials say that beginning in 2015, Charmoli, owner of Jackson Family Dentistry, 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 Xrays of the damage he caused,” according to a federal press release. “Then, Charmoli sent images of the damage he caused to insurance companies as support for his requests for payment for the crown procedures.”

In announcing sentence, Adelman called this an unusual case of fraud because Charmoli physically harmed his own patients and “intentionally damaged” their teeth. He said that Charmoli’s fraudulent conduct led to physical injuries and a loss of trust in the dental profession.

Adelman described Charmoli as “persuading,” “badgering” and “shaming” his victims and said that Charmoli was both “pushy” and “coercive.

Adelman also focused on the fact that Charmoli made his victims feel like “prey” and that he caused them significant pain and discomfort. The judge indicated that a period of incarceration was necessary to reflect the seriousness of this conduct, particularly because there was no “motive other than greed” for Charmoli’s crimes. In announcing the sentence, Adelman said it was important for other professionals in Charmolis position to know that this kind of fraudulent conduct would not be tolerated.

Federal authorities said that evidence showed Charmoli performed far more crown procedures 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,” the press release said. “In each of 2015 and 2016, Charmoli performed over 1, 000 crown procedures.”

The federal press release also said that in addition to submitting X-rays to insurance companies of damage Charmoli himself had caused, he made false statements to dental insurers when they denied initial claims for crown coverage.

Mr. Charmoli abused a position of trust and lied to his patients and their insurers simply to line his own pockets,” said U.S. Attorney Richard Frohling. “Despite having many advantages, Mr. Charmoli simply wanted more.”

According to the indictment against Charmoli, costs not covered by insurance needed to be paid by the patients. For example, between Jan. 2, 2016 and June 28, 2018, Charmoli submitted insurance claims of $745, 570 to Delta Dental. He was paid $318, 600.98, according to the indictment. Patients covered the rest.

Charmoli had faced a maximum term of 10 years in prison for each health care fraud conviction and a maximum term of five years of imprisonment for each false statement conviction.

The News Graphic reached out to Charmoli’s attorney, Ellison Hitt, for comment, but was unable to reach her.



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