Office manager sentenced for health care fraud

The manager of a Palo Alto dental office convicted of faking an insurance claim and pocketing more than $3,000 was sentenced this week to 45 days in county jail, according to the Santa Clara County District Attorney's Office.

Veronica Rivas, 39, of Fremont, was sentenced Nov. 13. Santa Clara County Superior Court Judge Shelyna Brown also gave Rivas three years of probation, and ordered her to pay $3,223.50 in restitution.

In early 2009, Rivas submitted fraudulent insurance claims to a dental insurance provider for orthodontic treatments for her husband and son. The procedures were never performed. When the insurance claim was paid into the dentist's account, Rivas then forged the dentist's signature on the 'patient refund' check. Rivas made the check payable to her husband. The dentist discovered the fraud and reported it to Palo Alto police.

"It may be tempting to try and cash out 'unused' insurance benefits, but it is a crime to submit false insurance claims for procedures which were never performed. Insurance fraud impacts everyone by causing insurance rates to go up," said Deputy District Attorney Denise Raabe of the Health Insurance Fraud Unit.


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Posted by harsh
a resident of Downtown North
on Nov 16, 2013 at 4:24 pm

Jail time sounds awfully harsh for a minor theft from a big corporation. Do corporate officers face any jail time when they steal millions or billions from the public? Of course not. Who wants to bet that some insurance company lobbyists paid the DA for this sentence?

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Posted by musical
a resident of Palo Verde
on Nov 17, 2013 at 4:54 am

Ask Martha Stewart.

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Posted by resident
a resident of Charleston Meadows
on Nov 20, 2013 at 10:23 pm

The problem with dental insurance is that it includes a provision for orthodontics even though the insured would never use it. I received a check in the mail for $1,500 to my address but for someone I never heard of - name not in PA phone book. Since it was for orthodontics assume it is a young male. I returned the check to the insurance company saying that it was sent to the wrong address, wrong name. I later got a request for verification from the California Tax Assessor asking if I was the occupier of the house. This relates to the Homeowner's Exemption. Went to San Jose - Tax Assessor to provide information and request detail of why the notice was sent to me - they would not explain. My suspicions are that 1. someone is using my address for the purpose of being in the PA school system; or the insurance companies are leveraging the available coverage across many policies. It is a matter of coincidence that is unclear but there is definitely a strange set of occurrences going on concerning dental insurance.

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Posted by NS
a resident of Another Palo Alto neighborhood
on Nov 21, 2013 at 10:39 pm

I am currently wading through another stack of medical bills, and finding once again the bills and insurance statements don't match up and I'll be spending the next few days on the phone straightening it all out so I can pay my bills. Along the way, I will verify some of the bills are legit, but verifying all is a Herculean task. As I opened and sorted the bills tonight, I recognized fewer than half of them because they are so poorly described.

I'm expected to pay copays in order to help me understand the cost of medical care, but all it does is suck more days from my life that I will never get back.

If insurers and providers had to work together to provide patients a way to settle their bills under their contracts when they get the care, or even get an accurate quote before they get the care, THEN copays would serve their purpose. And the above crime couldn't happen.

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