Manitoba dentist disciplined for falsifying records sent to insurance company

A Manitoba dentist has been disciplined and fined after admitting she submitted false billing information to a patient's insurance company.

The dentist purposefully altered the dates of treatment in the patient's chart and submitted invoices, lab billsand receipts to an insurance companyknowing that the records had false information about the treatment dates and fees charged, an inquiry into the dentist's conduct was told.

A complaint by an insurance company against Dr. Danielle Jobb, a dentist practising in Oakbank, Man., led to a hearing by an inquiry panel of the Manitoba Dental Association's peer review committee in August.

The dentist pleaded guilty to breaching the dental association's code of ethics by submitting false billings to an insurer, says the decision summary published on the MDA website in a quarterly bulletin.

"This was for the purpose of assisting a patient in obtaining benefits under dental plans which would otherwise be disallowed, in order to receive greater payment or reimbursement, and to make non-covered procedures appear to be covered," the decision says.

Reprimand, $10,000 fine

Jobb was reprimanded and fined $10,000, and was required to pay the costs of the investigation and hearing up to a limit of $45,000.

The insurer's complaint said the dentist completed dental work in one policy year, then billed it to the insurer in the following year, when the plan limits were renewed.

The dental services at issue were two dental bridges. A bridge is defined by the Canadian Dental Association as a dental restoration that replaces one or more missing teeth.

The decision says the patient's chart showed the first bridge was done in January and February of 2018 and the second in January and March of 2019.

But in April 2018, the patient was referred to another dentist, and that second dentist had a chart and documentation confirming that as of April 2018, the patient already had both bridges in place.

That information was inconsistent with the invoices Jobb sent to the insurer for the patient's second bridge.

The dollar amounts billed for the dental work in the case are not specified in the published summary of the decision.The dental association's fee guide for dentists suggests a fee of $2,700, plus laboratory fees, for a bridge used where one tooth is missing.

Dentist admits misleading investigator

Jobb "admitted her office contacted the lab and requested they provide false invoices, and that she then signed off on the insurance forms and submitted false invoices to the insurer," the decision says.

"The member admitted to altering the patient's chart to conform with the false billing," it says. She also "admitted to misleading the MDA appointed investigator by sending an email following notice of the complaint that both bridges 'were not seated at the same time,'" it says.

The hearing panel concluded Jobb "exhibited failings in integrity," which "tarnishes the reputation of the profession in the eyes of the public."

"The requirement of members to co-operate with and be truthful in the course of investigations is integral to self-regulation," the decision says.

The insurance company is not identified in the decision summary posted on the dental association website.

Asked for her perspective on the decision, Jobb said in an email to CBC News, "I don't believe there is anything more I can contribute to the matter than what you have read at the MDA website."

The inquiry panel that heard the case decided the decision would be published in the MDA bulletin and made available to the public.

There are almost 800 dentists registered to practise in Manitoba, MDA registrar Dr. Arun Misrasaid. In each of the last five years, the number of formal complaints filed about dentists ranged between nine and 17 annually, he said.

Misra told CBC News the dental association also receives queries from the public about issues in their dental treatment, which the MDA attempts to help mediate and resolve.

"The MDA is attentive to the public and community and very conscious of the public interest in all matters," Misra said in an email.