A former Jackson dentist has been convicted of health care fraud related to his high rate of crowning patients’ teeth, many of them unnecessarily.
Prosecutors said Scott Charmoli, 61, of Grafton intentionally damaged the teeth before doing the work, so the resulting crown would be covered by insurance.
Charmoli attached more than 1600 crowns over a period of 20 months. An insurance company executive testified that, on average, Wisconsin dentists placed fewer than six crowns per 100 patients, but that in 2019, Charmoli’s rate exceeded 32 per 100 patients.
The scheme was revealed after he sold the practice in 2019, with the new owners realizing after reviewing files that the crown numbers were out of the ordinary.
Charmoli was indicted in late 2020 on eight counts. After a four-day trial in federal court in Milwaukee, a jury found him guilty on seven counts: five counts of fraud related to four patients and two counts of making false statements related to two of the same patients.
The jury acquitted Charmoli of two counts of fraud related to two teeth from a patient for whom his work on a third led to a guilty verdict.
Charmoli faces up to 20 years in prison, but will likely receive a much more lenient punishment. His sentencing is scheduled for June 17.
He also faces medical malpractice lawsuits in Washington County, brought by nearly 100 former patients. Those cases have been suspended pending the outcome of the federal indictment.
Charmoli’s license to practice dentistry in Wisconsin has been suspended since February 2021 pending an investigation by the state Board of Dental Examiners. She was first licensed in 1986.
According to the indictment:
Charmoli initially showed a patient an X-ray of a healthy tooth, but pointed out a line or dot that he said indicated a fracture or decay. Then he would tell the patient that he needed a crown.
The indictment notes: “The patients, who believed Charmoli to be the expert, accepted his false statements and agreed to the crown procedure.”
Then, after breaking his tooth, Charmoli would have x-rays taken that would later accompany an insurance claim. Crown procedures are typically not fully covered by insurance, so Charmoli was not fully reimbursed for the claims he submitted, and patients had to make significant co-pays.
From January 1, 2016 through June 28, 2018, Charmoli received $318,600 of $745,570 in claims submitted to Delta Dental, according to the indictment. During the first six months of 2019, she collected another $114,294 in claims submitted to Delta.
A former Jackson Family Dentistry assistant testified that the office went from busy to extremely busy after it moved to a larger space and Charmoli consulted with marketing experts who urged the office to sell more services.
Baily Bayer said she noted significantly more procedures, tighter scheduling and a smaller staff-to-patient ratio.
She was new to the profession, she said, and thought it strange that X-rays were taken after Charmoli had done some piercings. She said he would say that she used to work in insurance, and “insurance is going to want to see this.”
Bayer said it became uncomfortable and stressful and he eventually left the office. Dentistry, he said, “shouldn’t be a sales pitch. It should be that you need it or you don’t.”
Former patient Todd Tedeschi testified that Charmoli convinced him that he should have two crowns done at once, to avoid repeat anesthesia, even though his teeth weren’t bothering him.
“It seemed excessive, but it didn’t taste any better,” Tedeschi said. “He was the pro. I just trusted him.”
Thomas Ogorchock, who is representing more than two dozen former Charmoli patients in one of the medical malpractice cases, said that when people started calling him, they were very angry.
“When people hear this story, they shudder,” he said. “It’s an interesting story, but a very sad one.”