Dentists Drilling for Dollars?

False dental claims drive up consumer premiums, max out benefits.

Jan. 21, 2008 — -- Some patients may expect their dentists to check for cavities during their visit, but instead, they find the dentist drilling for dollars inside their mouths. Insurance companies pay out millions annually in unnecessary dental claims.

Former patients of one dentist claim that is what happened to them when they visited Alireza Asgari. They say that not only were the procedures unneeded, but they also had long-lasting effects, and sometimes difficult infections.

"I can remember the tool he used to slice across my gums," said former patient Karen Trowbridge. "The tears were coming down my face."

She said Asgari told her during a consultation that she had a fractured jaw, which required surgery. In actuality, Trowbridge's jaw wasn't fractured. The dentist reportedly performed the surgery anyway, and instead of inserting a bone graft, he put hundreds of tiny beads into her gum line. They became infected and Trowbridge had to undergo multiple surgeries to have them removed.

Trowbridge wasn't Asgari's only ex-patient with complaints.

Former patient Amy Suda-Ruskey said the dentist gave her an unnecessary root canal.

"My tooth was perfectly healthy and I never needed that first root canal," Suda-Ruskey said. "It was very painful. My cheek was swollen."

"I did eventually lose that tooth and had to get a dental implant," she added. After her experience, Suda-Ruskey filed a civil suit against Asgari, which settled.

Asgari still faces dozens of other civil lawsuits, including another that was settled and three suits that are still pending.

"He did a lot of dentistry that was unjustified, and not only that, it was very aggressive, and he hurt a lot of people in doing this," said oral surgeon Richard Silberman.

The state of Pennsylvania, where Asgari practiced, agreed and convicted him of multiple counts of theft for billing insurance companies for unnecessary services. Today, Asgari is in jail and he is eligible for parole this May.

"He had their complete trust in those two hands that are working inside an individual's mouth, and he was just stealing money," said Pennsylvania Attorney General Tom Corbett. "That's all it was about."

Asgari's case isn't an isolated one.

"We're seeing a disturbing spike in the warning signals that there may be an increase in dental fraud by crooked dentists," said James Quiggle, of Coalition Against Insurance Fraud.

In fact, an ABC News investigation uncovered dental fraud cases across the country, which bilked insurance companies out of millions of dollars. One Brooklyn, N.Y., dentist wanted Medicaid to believe he filled 52 cavities in one patient's mouth in one visit.

"Everyone needs to be concerned about dental fraud," Quiggle said.

Besides unnecessary procedures, cases of phantom billing exist. In those cases, dentists bill insurers for services they never performed, which drives up insurance premiums and maxes out coverage limits without the patient's knowledge.

"I put my trust in him," said Amy Tomalinas, who settled her civil suit against Asgari for an unnecessary root canal.

"Dr. Asgari hurt me emotionally, he hurt me physically, he hurt me financially," she said.

Another patient, who has sued Asgari, said the dentist caused severe damage.

"I had seven abscessed teeth in my mouth at once. All seven root canals that he did on me were infected," said Joe Klein.

How to Protect Yourself

Patients suggest questioning any major procedure next time you're in the dentist's chair.

"Don't be pressured into thinking you have to make a decision right then," said Donna Klein, Joe Klein's wife and a fellow Asgari patient. "To this day, I grab the sides of the chair when I sit down."

Also, check out your dentist with the state insurance department, or local dental board, and review the explanation of benefits letter you receive from your insurance company.

"Get a second opinion if your insurance doesn't cover it, or pay for it, or you'll end up paying for it in the long run," said Tomalinas.

Most of all, trust your instincts.