Insurance Companies Nearly $900k Sentenced

Dentist Who Bilked Insurance Companies Nearly $900k Sentenced

San Diego County District Attorney Summer Stephan announced today that a Mira Mesa dentist, who fraudulently billed multiple insurance companies $866,700 claiming she performed 800 root canals on 100 patients, some of whom never stepped foot in her dental office, was sentenced to six years in prison after pleading guilty to three counts of insurance fraud earlier this year. April Rose Ambrosio, 59, who does not have specialized training as an endodontist to perform root canals, received more than $400,000 from ten insurance companies after billing them nearly $900,000, according to the San Diego County District Attorney. She has been ordered to pay restitution in the amount of $405,633.

Ambrosio, a general dentist, fraudulently billed 10 insurance companies $866,700 from 2014 to 2018 for 800 root canals which were never done. Her deception involved billing for work on days her office was closed, or she was noted as being on vacation, and, in one case, billing for more than 100 root canals over a three-month period for a family of four. In some instances, Ambrosio billed for root canals on non-existent or missing teeth, or she double billed for teeth she previously claimed to have performed root canals on.

“The way this defendant bilked the system is astounding,” DA Stephan said. “Unfortunately, when insurance companies get ripped off, consumers ultimately pay the price through higher premiums.”

The Department of Insurance spent two years investigating this case and worked closely with the District Attorney’s Insurance Fraud Division to bring Ambrosio to justice. Investigators say she was running the billing scam for four years.

Ambrosio never billed the patients for their portion of phony dental work which she billed to the insurance companies. In addition, Ambrosio’s license to practice dentistry has been suspended since September 24, 2019.

Insurance fraud in the U.S. costs consumers about $80 to $90 billion per year. In California, it is a $15 billion-a-year problem. Insurance fraud is the second-largest economic crime in America, exceeded only by tax evasion. The District Attorney’s Insurance Fraud Division is dedicated to preventing all forms of insurance through outreach efforts, investigation and prosecution. This team handles workers’ compensation fraud, disability insurance fraud, health care insurance fraud, auto insurance fraud and life insurance and annuity product financial abuse.