Gum disease is very common among adults, with 47.2% of people over 30 having some sort of periodontal disease. But while issues such as these are seen often by dentists, they weren’t as prevalent as one Sacramento dental office claimed.
Nichol Lomack, a former assistant at a dental practice operated by Dr. David Lewis, has been charged with health care fraud and has been sentenced to 21 months in federal prison. Dr. Lewis will serve three years and 10 months in federal prison as well.
Lomack was employed at Dr. Lewis’s office from 2001 until November 12, 2010. During that time, she was responsible for processing and submitting insurance claims to patients’ carriers in order to reimburse the office for dental services.
In late 2008 or early 2009, Dr. Lewis began targeting UPS employees for unnecessary dental treatment. Under Northern California General Teamsters Security Fund, UPS health and dental care plans are 100% covered without annual limits. Without a cap on what he could receive from the insurance companies, he began a scheme to falsify records.
Dr. Lewis and Lomack recorded false information in their books. They either recorded dental work that was not performed or led patients to believe that they had preexisting conditions in order to justify the work that was done.
In some cases, Dr. Lewis drilled into patients’ healthy teeth and installed temporary fillings, which his assistants took x-rays of. Lomack would pass these x-rays to insurance providers as tooth decay, justifying further procedures.
In addition to performing unnecessary dental work and false claims, Lomack and Dr. Lewis would bribe UPS employees with cash incentives. They would pay the patients for receiving dental treatment as well as referring the practice to other UPS employees.
The plea agreement says that Lomack took orders from Dr. Lewis to submit the claims to Delta Health Systems, the health provider for UPS, which was billed for the services. Lomack understood and knew at the time that she filed the claims that the records were falsified.
Acting U.S. Attorney Phillip Talbert said that Lomack’s actions were impermissible.
“This defendant assisted in a fraud scheme that not only plundered funds meant to provide essential services, but inflicted pain and suffering on patients by performing unnecessary dental procedures, all in the name of additional profit,” said Talbert.
In addition to time in federal prison, both defendants must pay restitution. Lomack and Dr. Lewis have been ordered to pay $726,300 each. Dr. Lewis has additionally been charged with a $75,000 fine.