Following a U.S. grand jury trial, Dr. Scott Charmoli was convicted of five counts of healthcare fraud and two counts of making false statements for engaging in a yearslong scheme to collect fraudulent insurance claims for unnecessary crown procedures. Charmoli, the former owner of Jackson Family Dentistry in Jackson, WI, reportedly billed insurance for more than $4.2 million for these procedures between 2016 and 2019.
In 2015, the 61-year-old dentist allegedly began aggressively selling patients on the need for crowns. After persuading them, the dentist used his drill to break patients' teeth, then took photos and x-rays of the damage. Charmoli, who was charged with the offenses in December 2020, presented the photos and x-rays to insurance companies as proof that the crowns were necessary and therefore eligible for reimbursement, according to evidence presented at his trial.
Insurance companies assumed the images and x-rays of patients' tooth damage represented preoperative conditions, so they paid Charmoli for the dental work. Also, this led his patients to pay significant copays for the unnecessary procedures, according to the release.
From 2016 to 2019, Charmoli performed many more crown procedures than most dentists in Wisconsin, ranking him at or above the 95th percentile of crowns performed for each year, according to data that was presented at the trial from one insurance company.
In 2015 and 2016, Charmoli performed more than 1,000 crown procedures each year. In 2017 to 2019, the dentist performed more than 700 crowns per year, according to the U.S. attorney's office.
In addition to submitting x-rays and photos to insurance companies, evidence presented at the trial showed that Charmoli lied to dental insurers when initial claims for crown coverage were denied, according to the release.
Charmoli is set to be sentenced on June 17, 2022. He faces up to 10 years in prison for each conviction of healthcare fraud, as well as up to five years in prison for each conviction of making false statements.
In January 2019, Dr. Pako Major purchased Jackson Family Dentistry from Charmoli. Despite the sale, Charmoli continued treating patients through August 2019, according to a statement on the dental practice's website.
After Charmoli departed the practice in August 2019, Major reviewed the files of past patients and discovered evidence of potential misconduct and unethical practices committed by Charmoli during his tenure. These suspicions led Major to report the conduct to authorities, according to the statement.
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