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Financial Crime: King of crowns: Wisconsin dentist convicted of breaking patients’ teeth to submit $4.2 million in bogus insurance claims

A Wisconsin dentist was found guilty of telling patients they needed unnecessary crowns and then breaking their teeth with a drill to convince their insurance carriers to pay for the cost of the procedures.

Dr. Scott Charmoli, 61, of Grafton, Wis., was accused of submitting $4.2 million in bogus claims to insurance companies for crowns that his patients never needed.

Federal prosecutors said that, between 2015 and 2019, Charmoli submitted far more claims for crowns than did others dentist in the state of Wisconsin. In some years, he performed more than 1,000 such procedures on patients at his Jackson Family Dentistry practice. 

Last week, Charmoli was convicted by a jury of five counts of healthcare fraud and two counts of making false statements. He faces up 60 years in prison when he is sentenced in June.

An attorney for Charmoli declined to comment.

According to court documents, Charmoli would tell patients they needed crowns even though many didn’t. Most patients, trusting in his expertise, would agree to his dental-care recommendations. 

Charmoli would use a drill to break a patient’s tooth and then instruct his assistant to take a photo or X-ray of the damaged mandible, which he would submit to the insurance company as having been taken before the procedure. 

“By breaking the patient’s tooth, Charmoli would cause permanent disfigurement and bodily injury,” prosecutors alleged in court documents. 

Many of the patients also incurred significant out-of-pocket costs as their insurance typically only covered part of the cost of the procedures.

Charmoli was accused by prosecutors of performing over 1,000 such procedures in 2015 and 2016 and over 700 each year from 2017 through 2019. That put him in the top 5% of all dentists in Wisconsin, in terms of number of crown procedures performed.

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