CASE: DENTAL INSURANCE FRAUD AND SCAMs IN PHILADELPHIYA, KEYSTONE HEALTH, Medicare &
I am writing to you to inform about big Dental/Health Insurance Fraud going on in Philadelphia, PA. I am affected personally and have been basically depraved of dental benefits since I got sick/disabled. Keystone Health Insurance is my great partner in battle with incurable deceases. However, immoral people in "Dental Groups" offices all over Philadelphia, please, take into account that doctors are good but their turn over coefficient is extremely high. All that positive reviews are meant for them. It's The manager who is doing all the 'office 'work.' To keep it short, here is how the Fraud committed at Flawless Dental Group:
1) The environment very pleasant, a Doctor(who ever in the office) does only 1-3 fillings only and gives you a page with addresses of specialist doctors for you to do root canals/pull the teeth (all of them are PRIVATE PRACTICES and do not work with Keystone/Medicaid/Medicare) I still have the list. You can not come back to finish treatments without doing those super expensive procedures first. I found only one specialist within our KS Network "Dr. Ahmed S. Abdelkader D. D. S Practice." Claims were declined, twice. So, no service but 3 filings were performed to me in total.
2) After a patient not capable to pay for those super expensive procedures on the list, he/she most likely not coming back. And that's exactly what the scammers want.
3) After pandemical restrictions were eased, I called to Flawless Dental Group on 06/17/2020 to see if they are back in business and to schedule an appointment to finish all fillings because Insurance Keystone Health explained to me that Dental Group can not deny me these services (which i knew)-- "ALL FILLINGS ARE COVERED." However, the Receptionist told me not to come because my benefits all are used and no benefits left for this year, come back next year. I answered that my insurance covers much more than 3 fillings /yr and that now I see clearly how they operate.
As soon as client leaves the office, they even do not wait till the end of the year to 'drain' your accounts. I got so upset, almost had severe seizure, I have metastatic cancer to brain.
Conclusion: Flawless Dental Group and alike- CRIMINALS AND COWARDS. The same was done by other "Dental Groups " with in past 6 yrs. They all have ONE 'Master Mind'. Flawless Dental kept one promise on their website: "Insurance Benefits - Let Us Help to maximize them and utilize to the fullest. This is the 'service' FDG provided, even though I didn't ask to 'drain' my benefits. Without providing the services I came for. The Manager refused to provide his last name but it's OK-first name just enough-Ilya. They even do not provide you any receipts for so called services provided -none! By the way, required by Business Law.
Moreover, the medical form you sign when you come to their office is illegal. DO NOT SIGN! I did not know but was surprised how much very personal info they collect. The insurance agent who was filing the allegedly dental insurance fraud complaint advised me to check my credit report more often now and couple other actions because they collected enough information about you to commit any fraud now. It is clear insurance fraud.
Do not rely on their fake 'niceness'. Instead, try to come back later, in couple months, or try to schedule another appointment by phone. You will see right away what I mean and how rude they will be and disrespectful.
Maybe, You will be also surprised very soon that your insurance was used by 'you' in different state, like NJ, and some doctor submitted claim in your name that you had a 'visit ' with him. Even though you have not been to that state, city, nor ever seen that doctor. All it took my neighbor to make a visit to Dental Group couple of month before it all started but it is a new case, it just 'fell' on my desk 3 days ago. This story was just reported and it shows deeper problem. Connect the dots. Organized crime.
Most people who went to dental/medical group once and didn't come back that year, not even aware that their privacy was violated and their benefits are flowing into scammers accounts. Not just that, it becomes easy to do any financial crime against us
Please, submit your experiences, facts to insurance fraud department, even FBI has designated department, private citizens groups help to chase scammers.
Work with your insurance, be proactive and check what bogus claims have been submitted to your insurance account, if any, and report back to it.
Insurance fraud is one of America's largest crimes at least $80 billion is stolen each year and $68 of them is health insurance related. Does anybody care? Or maybe let just Eastern- European nationals-criminals (allegedly) simply have it all? Just think of this: luxury life without a day of real work. Our American doctors also can not resist to participate in this easy money making system: minimum work and the sky is a limit for their "unearned income" from Tax Law stand point. Shame on those who abuse elderly and disabled!