United States Attorney Richard G. Frohling of the Eastern District of Wisconsin announced that on March 10, 2022, Scott Charmoli (age: 61) of Grafton Wisconsin, a licensed dentist, 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 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. Many of Charmoli’s patients also paid significant co-pays for these crown procedures.
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 each of 2015 and 2016, Charmoli performed over 1000 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.
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.
The Federal Bureau of Investigation investigated the case, which Assistant United States Attorneys Julie F. Stewart and Michael A. Carter prosecuted.
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