Success Stories

United Concordia's Special Investigations Unit (SIU) is responsible for coordinating all fraud investigations with various Federal and State law enforcement agencies. These agencies include, but are not limited to, the Federal Bureau of Investigations, Defense Criminal Investigative Service, State Insurance Fraud Divisions, State Attorney General's Offices, and United States Attorney's Offices. SIU relies on various methods to detect unusual patterns that may indicate fraud. These methods include data analysis, referrals from patients/dentists, and anonymous sources. SIU investigates all cases of suspected fraud and when warranted, aids in the prosecution of individuals to the fullest extent of the law. The following success stories illustrate SIU's efforts to date.

May 2008

Dentist Pleads Guilty to Health Care Fraud

In May 2008, an Aliquippa, PA dentist plead guilty in federal court to a one-count charge of Health Care Fraud. In connection with the guilty plea, the Assistant United States Attorney advised the court that from May 17, 2004 through May 25, 2006, the dentist made $94,098 in fraudulent claims to United Concordia Companies, Inc. for reimbursement of dental treatments and services to patients which were either never performed or which were different than the actual dental treatments and services performed.

On September 24, 2008, the dentist was sentenced to three years of probation, to include six months of home detention.

November 2005

Dentist Pleads Guilty to Theft Charges

In September 2005, a former Hanover Township, PA dentist plead guilty to a total of 42 felony counts consisting of theft and criminal attempt to commit theft, and 37 misdemeanor counts of the same crimes. In exchange for his guilty plea, the State of PA, Deputy Attorney General withdrew 32 counts of insurance fraud against him.

In November 2005, a Luzerne County Judge sentenced the dentist to 2 1/2 to 5 years of imprisonment. The Judge told him that he can not practice dentistry, or be associated with any dental practice, as long as he is in prison, on parole or serving his 15 years of probation. The dentist is required to pay restitution in the amount of $90,386 to various insurance companies and patients who paid him out of their pockets. The dentist, who is a native of Iran, could face deportation from the United States following his imprisonment.

The dentist also faces more than 160 civil malpractice lawsuits that have been filed by former patients alleging that he performed shoddy dental work. Several patients claimed he embedded broken dental tools in their teeth causing them pain and suffering, according to the civil lawsuits. At least eight civil lawsuits are ready for trial scheduled to begin in early 2006.