California Dentist Pleads Guilty to Scamming Teamster Benefit Plan

dollarsDavid M. Lewis for a while seemed as resourceful in his billing as he was in his drilling. But in the end, the Sacramento dentist was too clever by a half. On January 11, Lewis pleaded guilty in U.S. District Court for the Eastern District of California to defrauding a Teamster-sponsored health care plan for United Parcel Service employees out of at least $1 million in unnecessary or nonexistent work. He had been indicted on 18 counts in February 2014 following a probe by the U.S. Labor Department’s Office of Inspector General and Employee Benefits Security Administration, plus the California Attorney General’s Office and Dental Board. A former Lewis employee, Nichol (Ramirez) Lomack, earlier had pled guilty.

According to court documents, Lewis, now 62, in late 2008 or early 2009 began targeting UPS employees for dental work who had 100 percent coverage, with no annual limit, under the Northern California Teamsters Security Fund. The plan was designed by Delta Health Systems. Unfortunately, his “work” often was something less than that. In some cases, Lewis falsely billed the plan for procedures not performed. In other cases, he performed unneeded procedures on healthy teeth, including root canals and temporary fillings, billing Delta for reimbursements. For fillings, he would tell his assistants to take X-rays and send them to Delta as evidence of “tooth decay” justifying further work. Lewis also was an enthusiastic promoter. He frequently offered cash and noncash incentives to covered employees for making appointments and for persuading fellow workers to make appointments. Labor Department investigators estimated the total fraud at $1 million and possibly more.

The scheme unraveled in December 2010 when Nichol Lomack, a former longtime insurance claims manager for Dr. Lewis, went to the California Dental Board with allegations of wrongdoing by Lewis. During the interview, she acknowledged her participation in the offenses. The board conducted an audit and concluded that fraud indeed had taken place. The U.S. Department of Labor, in a separate audit, concluded the same thing. The DOL handed the case over to the Justice Department, whose investigation led to a February 2014 indictment of Lewis on 18 fraud-related counts. The California Dental Board already had imposed an interim and then permanent suspension of the defendant’s license to practice. With Lomack already having pleaded guilty, Lewis faced the music and pleaded guilty this January.

David Lewis, originally set for sentencing on March 31, will learn his fate this Thursday. Nichol Lomack, the noble whistleblower, is scheduled for sentencing on September 1. Each faces up to 10 years in prison and a $250,000 fine. The most onerous consequences have been borne by patients. Lewis’ “treatments” on more than one occasion resulted in injury and even disfigurement. Delta Health Systems might consider instituting a co-payment dental plan, not to mention more rigorous vetting of participating dentists in its Sacramento-area network – if the International Brotherhood of Teamsters doesn’t object.