Nisha M. on BBB
2 years ago
05/07/2018, 06:04 AM
Gursimrat K*** S*****, DDS, and her office manager, Alejandra E*******, at Laguna Smiles, **** ****** ******* ****** ***** ***, are fast-talking swindlers, who are engaging in illegal and unscrupulous business practices.
I believe S***** has knowingly and willfully executed and attempted to execute a scheme to defraud and to obtain, by means of materially false and fraudulent pretenses, representations, and promises, money owned by and under the custody and control of private insurers, in connection with the delivery of and payment for health care benefits, items, and services. S***** has submitted fraudulent bills to GEHA (my dental insurance provider) and Care Credit (a third party healthcare financing company) for services never rendered, as well as services unauthorized by the insurance provider as they were not medically necessary, all of which is a violation of Title 18, United States Code, Section 1347 (Healthcare Fraud). Also, S***** knowingly transmitted and caused to be transmitted by means of wire communication in interstate commerce certain writings, specifically, billing claims to my insurance provider for services that were never rendered, in violation of Title 18, United States Code, Sections 2 and 1343 (Wire Fraud).
Here is how it all started: My three children and I went to Laguna Smiles on December 28, 2017, for the first time to obtain a checkup and routine teeth cleaning. The elderly billing clerk assured me that they accepted my insurance. In fact, the billing clerk kept telling me how “wonderful” my insurance provider was, that is, Geha – for federal employees, and that their coverage was excellent. After my dental exam, Dr. S***** told me that I was in need of a deep cleaning since I was developing periodontal disease. This frightened me and I agreed to get the procedure done after the billing clerk told me my out of pocket expenses would be $281, not realizing that the dentist never even did the basic cleaning for which I came into the office to get. Dr. S***** convinced me that my family’s teeth were horrible, and we were in desperate need of invisalign. I agreed to get it done after the office manager gave me paperwork indicating that my insurance would pay $2,500 and my out of pocket expenses would be approximately $1,550 for each of us. I applied for a Care Credit account to cover the out-of-pocket expenses, which amounted to approximately $6,200. My kids had their invisalign x-rays done, but I did not since I was not feeling well.
On the following date (1 day later), I called the dental office and cancelled the orthodontic services because I felt the old-fashioned metal braces was the better teeth straightening method for my family. The receptionist assured me she would pass the message onto the office manager and that I could ask the dentist about metal braces when my kids and I returned for a follow up appointment in two weeks.
On January 13, 2018, the office manager, Alejandra E*******, acknowledged she had received my message to cancel invisalign. She looked me in my eyes and assured me that she had cancelled the charges to my Care Credit account and that it would take a few days to reflect on my statement. I made the mistake of believing her. Not knowing that Alejandra was a liar and thief, I proceeded to allow the dentist to fill what I believed to be "new cavities" in two of my kids' mouths. At first, Alejandra told me the price be like $1,000 to have the eight cavities filled. I told her that amount was too expensive and that I would just wait until we could get in to see our regular dentist at another office. Then, she began negotiating with me and the price came down to about $380. She explained that my kids were getting the composite fillings as opposed to metal fillings. I agreed and paid the charges. About one week later, my insurance provider contacted me and informed me that my kids did not need to have fillings for cavities that had already been filled within the past year or so. Unbeknownst to me, Dr. S***** removed my kids’ metal filings and replaced them with composite filings in order to rack up unwarranted fees. In addition, my insurance provider reviewed my dental x-rays, which were taken by my regular dentist 6 months prior, and determined that I did not need to get a deep cleaning. They said I could not have developed periodontal disease in 6 months. Further, my insurance provider informed me that the dentist had submitted bills for orthodontic services of more than $21,000 for my three children, and that they had reached out to Dr. S***** for an explanation. When I told my insurance provider that I had initially agreed to get invisalign but cancelled on the following date, they directed me to call Dr. S***** to get this matter resolved.
I called Laguna Smiles and spoke to the office manager (Alejandra E*******). She claimed that I did not cancel the orthodontic services for all four members of my family but only three of us. I demanded that she review and listen to my call from December 29, 2017, since they have a recording that indicates that all calls to their office are recorded. She stated she would listen to the call and contact me. Days went by and I never heard from the dental office. When I called back and asked to speak to the dentist, Alejandra E******* refused and stated since we are in a dispute, the dentist would not speak to me and I had to work it out with my insurance provider. Alejandra E******* also wrote a letter to Care Credit and falsely claimed that the charges were justified since I did not cancel for my entire family. She also falsely claimed that the office attempted to resolve this issue with me, but I refused to speak to them. Alejandra E*******, you are a liar! You refused to talk with me.
My insurance provider directed me to file a complaint with the California Dental Board. I am taking this dentist to court in hopes of having the unwarranted billing claims submitted to my insurance provider of approximately $23,500 be reversed, and that the $7,000 in Care Credit Account charges (which now includes late fees) be rescinded. I am also seeking to have criminal charges filed against this Dr. S***** in order to deter her and others from engaging in illegal and unethical business practices.