Question
What is the name of your state? TN
so, the story starts in the fall 2005, when my husband went to some dentist to have his teeth checked. he had some job done and among others the dentist said that my husband needed 3 fillings, but they wanted to do it later, as there were more important things to do, such as a bridge. so they didn't have any fillings done in 2005, but they already charged my husband's insurance company for them. the fillings are still not done (they want to work on them in nov.2006). and the question is whether or not charging for the job which is not done in the same year is a fraud?
Answer
What is the name of your state? TN
so, the story starts in the fall 2005, when my husband went to some dentist to have his teeth checked. he had some job done and among others the dentist said that my husband needed 3 fillings, but they wanted to do it later, as there were more important things to do, such as a bridge. so they didn't have any fillings done in 2005, but they already charged my husband's insurance company for them. the fillings are still not done (they want to work on them in nov.2006). and the question is whether or not charging for the job which is not done in the same year is a fraud?
Yes, charging for services not performed is fraud. However, you would have to prove that the dentist did not do the work.
Answer
Are you certain they actually charged for the work, as opposed to sending in a pre-authorization? Since dental insurance tends to be limited, pre-auths are much more common for dental insurance than for medical. And a pre-auth includes the amount of the charges.