Can a dentist go to jail for waiving copays and deductibles

Thanks for using . I am Josh King, General Counsel for . Because we are receiving so many questions right now, it may take longer for some of our loyal lawyers to get back to you. In the meantime, I wanted to offer some preliminary help. Please keep in mind that I am not a NY lawyer, and to get a definitive answer on this you should consult a top -rated lawyer in your area. You'd really need to provide more information here. If the dentist is commiting fraud on an insurance company, there could potentially be criminal liability. If the dentist is simply performing pro bono dental work (by, for example, reducing charges by the amount of the co-pay), there should be no criminal issue. Note, however, that insurance programs may well require that co-pays be charged, not waived, because co-pays act as a throttle on demand - that's where fraud can come in if the dentist reports that co-pays are being charged where they are not. There is also the potential for civil liability - or, more likely, loss of participation in an insurance plan - even in the absence of any criminal liability. I'd recommend consulting with a good local attorney to go over the specifics of the practice and the insurance plans involved.

Waiving copayments or deductibles is almost always a violation of the contract between the insurance company and the dentist. The Dental Board in California would consider such a violation cause for suspending or revoking the dentist's license - and any other licensed dental professional (RDH or RDA) would also be subject to the same license penalties. I suspect other states are similar. You would think that the possible exclusion from a valuable insurance panel, a lawsuit for recovery of insurance benefits, and the threat of no longer being allowed to practice dentistry would be enough of a deterrent. Jail, I suspect, is an unlikely result - although (technically) fraud statutes in all states would allow some jail time to be given for fraud that reaches a certain monetary value. Defrauding the insurance company out of $100 is not going to get the district attorney up in arms - but $100,000 of $1 million would be another matter entirely. If this is dental staff involved in billing who is asking the question about his or her boss' practices (and I suspect it is), you have a problem, since it is likely you would be considered complicit in the dentist's fraudulent billing practices. I'd suggest looking for other employment, since I suspect this dentist is going to get himself caught eventually. Good luck!