Update: 11/25/2023

Charges dropped in Miami-Dade ‘Tooth Fairy Heist’ dental fraud case (local10.com)

How to get charged with a felony in 5 easy steps.

HIALEAH, Fla. (April-12-2023) – Five people employed by a dental management company were arrested Tuesday in connection to a $1.3 insurance dental fraud scheme involving two South Florida dental clinics, according to arrest reports.

Investigators with the Florida Department of Financial Services’ Bureau of Insurance Fraud dubbed the case the “Tooth Fairy Heist.”

Authorities arrested two women and three men on multiple felony charges:

  • Mercedes Linares, 53, of Hollywood
  • Christi Olson, 47, of Hialeah
  • Leonardo Ramos, 22, of Hialeah Gardens
  • Leonel Ravelo, 34, of Hialeah
  • Ryon Vazquez, 33, of Miami

Step 1 – Buy a Dental Practice

According to arrest reports, in 2020, a husband-and-wife pair sold shares in their dental practice, with offices located in Hialeah and Miami’s Little Havana neighborhood, to the management company, with the intention of having the management company handle administrative duties.

Step 2 – Fire the Original Owners

However, the two began to have conflicts with the company’s activities and were eventually fired from what used to be their own practice in April and May 2022, according to the report.

The pair had raised objections to the company’s non-dentists “trying to impose and implement operations” that violated Florida statues related to proprietorship of clinics by non-dentists, the reports state.

According to the report, the fraud began after the pair’s firing.

Authorities said the company continued to bill insurance companies for procedures under one of the dentists’ National Provider Identifier, known as NPI for short, despite the fact that she was no longer with the practice and had, in fact, been trespassed from it.

According to the arrest report, the dentist’s NPI was used because the new owner of the practice, while being a dentist, was not credentialed by insurers and did not have an NPI himself.

That lasted from May to September, until the clinic management began the proper enrollment process, it states.

It’s not clear if that dentist will face any charges.

Step 3 – Implement a “New Billing Process”

According to the report, the suspects also asked six associate dentists to “accept a new billing process” in which procedures done by dental assistants “would be signed off by the existing credentialed doctors even though they did not administer or supervise the treatments.”

The dentists “disagreed with this process because they weren’t supervising, would not be compensated and did not want their licenses used without their direct administration,” the report states.

One dentist did allow billing for services “she did not perform but only for her and the doctors she agreed to supervise.” It’s not clear if she will face charges.

Authorities said Ravelo directed the Little Havana practice office manager to use something called a “behavior management code” on all children under age 6 “without the knowledge and consent of the doctors to increase production and meet their financial goals for a monetary bonus.”

Step 4 – Get a Firsthand Lesson in Ethics

The six dentists discovered this “scheme to defraud by adding claims for services not rendered” and stopped the billing, the report states, and conducted an audit of all “behavior management code” claims.

Their audit revealed 50 fraudulent claims — four of which had already been submitted, totaling $1,800 in fraud.

Step 5 – Find Yourself Arrested and Charged

“Material evidence, sworn recorded witness statements and financial records will show that Olson, Vazquez and Ravelo had the knowledge and colluded to correct and cover this up after being confronted by (the dentists),” investigators wrote in the report.

The total amount of fraud involved was $1,350,246.35, authorities said.

Charges for the quintet include filing false insurance claims, organized scheme to defraud and criminal use of personal identification information.

Company Statement

The company at the center of the allegations, AC Pediatrics Dentistry & Orthodontics, released a statement to local news denying the allegations and blaming “disgruntled former employees.”

“AC Pediatrics Dentistry & Orthodontics is involved in an ongoing legal dispute with the former founders of the company, and in a related investigation from the Florida Bureau of Investigation. Despite maintaining complete innocence from any criminal wrongdoing, and actively cooperating in the process, we lament recent developments which led to the arrest of five company executives. Sadly, the origin of this ugly debacle traces to disgruntled former employees who were removed from their roles in 2022, and are now fixated on tearing down the company they worked for, regardless of the human toll.

The accusations pertain to administrative technicalities from which we had zero financial benefit, and which harmed absolutely no one. As such, AC Pediatrics continues to actively work with the State to demonstrate company and individuals’ innocence.

We operate with the utmost integrity, and take these charges very seriously. We strongly refute the accusations being leveled against us and look forward to a full exoneration as the legal process unfolds.”

Company statement

Source on File