Dentist who intentionally broke teeth sent to prison

Grafton man who did damage so he could charge for crowns gets 4.5 years
By 
BILL SCHANEN IV
Ozaukee Press staff

A dentist who lives in Grafton and practiced in Jackson was sentenced in federal court last week to four-and-a-half years in prison for intentionally breaking his patients’ teeth so he could install crowns, then bill them and their insurance companies for procedures they otherwise wouldn’t have needed.

Scott Charmoli, 62, was also sentenced by U.S. District Court Judge Lynn Adelman to three years of supervised release following his incarceration.

A federal grand jury indictment returned in December 2020 charged Charmoli with 10 felonies accusing him of running a health care scheme that began on at least Jan. 1, 2016, and continued through Sept. 31, 2019, in which he would show patients lines or spots on X-rays of their teeth and tell them they were fractures or decay that required crowns.

During the procedures Charmoli conducted at Jackson Dental Clinic, which he owned, he would break off a portion of his patients’ teeth and record the damage to justify insurance claims, according to the indictment.

A jury convicted him of seven felonies — five counts of health care fraud and two counts of making false statements related to health care matters — during a four-day trial in Milwaukee federal court in March.

During one 20-month period, Charmoli submitted nearly $2.1 million in claims for crowns to insurance companies.

“That amounts to over 1,600 crown procedures over a 20-month period, or more than 80 every month,” the indictment states.

Since insurance companies don’t typically pay the entire cost of crown procedures, Charmoli did not receive the full amount for the claims he submitted, although he did receive significant insurance payments and, as the indictment notes, the cost of procedures not covered by insurance is often paid by patients.

According to a statement from Greg Theis, vice president of dental services for Delta Dental, which was introduced at trial, the insurance company paid Charmoli’s clinic $639,159 for 1,294 crown procedures from Jan. 1, 2015, through July 1, 2019.

A review of X-rays submitted with the claims showed that those taken the day of the procedure were inconsistent with X-rays of the same teeth taken previously, indicating that the same-day X-rays were likely taken after Charmoli began the procedures, according to Theis. Delta Dental expects dentists to submit X-rays showing the pre-operative condition of teeth.

Charmoli’s scheme was discovered after he sold his practice in 2019 and the new owners reviewed files that showed the number of crown procedures he performed was remarkably high.

After Charmoli sold the Jackson clinic, he opened a new office in Hartford.

He has surrendered his dental license and paid a fine of more than $1 million.

He now faces several medical malpractice lawsuits brought by nearly 100 former patients in Washington County.

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