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Dental Fraud On The Rise Across U.S.-Mexico Border

Posted: 6:20 pm MDT April 18, 2006

A visit to the dentist can be painful and costly, not only for you, but for your medical insurance company. Most medical insurance companies will pay for procedures done in foreign countries, and it's legal for patients to have them done abroad. The problem is the Federal Bureau of Investigation reports dental fraud is becoming a major problem along the U.S. -Mexico border.

"What we tend to see is that there are dentists in Mexico who are fraudulently billing U.S. insurance companies," said Andrea Simmons, a special agent with the FBI.

Last year KFOX reported on the arrest of Jose de Jesus Betancourt, a Juarez dentist who allegedly billed U.S. insurance companies more than $1.9 million for procedures he never performed. Meanwhile, many border residents look to Mexican dentists for treatment.

"I was motivated to get it done there because the cost was supposed to be less than here," said Richard Meagher of West El Paso. In fact, some Mexican dentists will waive your deductible, but dentists on this side of the border said patients are not getting the same quality care.

"When you go somewhere such as Mexico they don't require the same lengthy degree program we do here in the U.S. Many of the programs are a combination of undergraduate schooling and dentistry where their level of education is just not equal to the United States' programs," said Daniel Castro, an El Paso dentist.

Regardless of where patients receive treatment, they're insurance company gets charged the same rate. However, when dentists start billing insurance companies for false procedures, it could end up costing consumers .

"If you go to a legitimate dentist and say, 'I've got to have this done,' and the insurance company says, 'I'm sorry, we've paid out the maximum on your plan for this year,' the patient is stuck having to pay for that procedure," said Simmons.

Despite these facts, some El Pasoans who can't afford dental care insist on getting treatment across the border. In some cases it can lead to medical complications

"My father-in-law got his dentures in Mexico, and he can't even eat with them because they're too large for his mouth. But I would be tempted to go because dental insurance is to expensive, and I would loved to have my teeth worked on," said Debbie Cadena from West El Paso.

The FBI states medical insurance companies lose millions of dollars a year to fraud, which forces them to increase their rates.

The FBI also warns malpractice insurance is very different in Mexico, where doctors are not required to have it. Therefore, filing a lawsuit against a Mexican dentist can be difficult.

In order for consumers to protect themselves and their insurance company against fraud , they should make sure the date of service on their insurance statements coincide with the day a procedure is done . Consumers should also keep track of what procedures the dentist performed to make sure their insurance company isn't getting billed for additional procedures. Patients who don't understand the medical terms on their statement should contact their insurance company, not their dentist.

Helpful links:

Check the legitimacy of a Texas dentist.

Check the legitimacy of a New Mexico dentist.

Mexican dentists are required to register with the health department at the federal and state level. However, there is no easy way of checking the legitimacy of a Mexican dentist, but consumers can try to contact the Colegio Nacional de Ciruganos Dentistas to verify if they're are licensed.

Patricio Sanz 1747

Interior C-103

Col. del Valle

Del. Benito Juarez

Mexico, D.F. 03100

Phone: (52 +55) 5524-1190

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