SUBMIT A COMPLAINT

West Coast Dental, South Gate, California / Partial denture and work not performed

Contact information:

For the most part, a letter to my dental insurance carrier best describes my situation and complaints.

You indicated to me in your letter of February 16, 2017 that West Coast Dental responded to you including the following statements:

A. “ … before services were rendered you were given different options, and the best choice was for a partial which you accepted.”

This statement is untrue, because I was given false information and aggressively mislead regarding the procedures and their costs. Under those circumstances, how can it be said I “accepted”?

Specifically, I was told by Dr. Shah the two covered benefits in my Blue Shield Dental Plan were inferior, and he advised me to try an uncovered procedure that was “much better”. Other patients who tried it were “very pleased with it”.

The two covered partials were made of a “hard” plastic. The ones he recommended were made of a “softer, better-fitting, more comfortable compound”.

If I tried his recommendation and was not happy with it, we would stop, and West Coast Dental would give me a statement credit for the full amount. Then we would try something else.

He also stated his “credit promise” to me at least twice more, on different occasions, on one occasion adding, “Don’t worry. If you are not happy, we will give you a credit – even if the procedure is completely finished. If you are not happy with it, just say so, and we will try something else.”

In addition, he told me, “If I tried his recommendation, which cost $1500 each (upper and lower partial dentures $3000), he would give me a discount on my other work, in effect, not billing me for the extractions I needed.

And as a note, Dr. Shah’s business card and the plaque on the West Coast Dental, South Gate office says “Managing Dentist”. So there shouldn’t be any question about his authority or whether he acted in the name of West Coast Dental.

Reference: ADA Principles of Ethics and Code of Professional Conduct
SECTION 5 — Principle: Veracity ("truthfulness")
5.B.1. Waiver of Copayment. A dentist who accepts a third party payment under a copayment plan as payment in full without disclosing to the third party that the patient's payment portion will not be collected, is engaged in overbilling. The essence of this ethical impropriety is deception and misrepresentation; an overbilling dentist makes it appear to the third party that the charge to the patient for services rendered is higher than it actually is.
It turns out that he made repeated false and misleading statements to me. As indicated below, he violated stated ADA Principles of Ethics and Code of Professional Conduct, specifically regarding veracity.

Reference: ADA Principles of Ethics and Code of Professional Conduct
SECTION 5 — Principle: Veracity ("truthfulness")
The dentist has a duty to communicate truthfully.
This principle expresses the concept that professionals have a duty to be honest and trustworthy in their dealings with people. Under this principle, the dentist's primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity.
Code of Professional Conduct
5.A. Representation of Care. Dentists shall not represent the care being rendered to their patients in a false or misleading manner.
You indicated to me in your letter of February 16, 2017 that West Coast Dental responded to you including the following statements:

B. “ … there was an issue with the first partial, and as a courtesy, they made a new one, unfortunately you are still unhappy with the new partial …”

This is simply untrue. After I had repeatedly told them to stop …

… I told Dr. Shah, I called and told the receptionist, I told Marisol (in Accounting) repeatedly, I told the new dentist assigned to me after Dr. Shah left, I told the dental technician who did the pre-dentist workups …

… they simply would not stop. The dental technician came in in a subsequent appointment to make new gel fittings. I asked him, “What is that? What are you doing?’ He responded, “I am taking new fitting.” After he was done, I asked him, “Why are you doing that?” He responded, “To fit your new partials.”

I responded immediately, “I do not want new partials. I have told them that over and over!”

He responded, “Well they said, just give us a chance to make them right.”

I responded, “No. I do not want partial dentures, period. So please just stop.”

And please note, they say, “… I was not happy with the new partial.” That is untrue: they never made a new partial.

They did not make a new partial, and they asked me to return the first partial, the one they did deliver, the one I was unhappy with. Marisol told me to return it, which I did, because she “could not request the statement credit for me if I kept it. They would say it had been delivered, that is, procedure completed and accepted by the patient.”

You indicated to me in your letter of February 16, 2017 that West Coast Dental responded to you including the following statements:

C. “ … the dental work was done properly and all services were performed within the dental standards.”

That is an "assertion" on their part and untrue for several reasons:

• the most they delivered was a first fitting, and
• they lied about their procedures in order to get me to accept their recommendation.
• In summary, I paid $3000, for which I got nothing. I have nothing, nothing, for $3000, nothing, zero.

Reference: ADA Principles of Ethics and Code of Professional Conduct
SECTION 5 — Principle: Veracity ("truthfulness")
5.B. Representation of Fees. Dentists shall not represent the fees being charged for providing care in a false or misleading manner.
You indicated to me in your letter of February 16, 2017 that West Coast Dental responded to you including the following statements:

D. “ … we asked them about the credit you requested, but they did not give us any information regarding it.”

That is the same response they have given me – no information. They do not want to address the issue directly. But since everything was prepaid, they were paid in advance, they continue to keep my money for no services performed.

I repeat, for $3000 I have received nothing. I have no partial dentures. The one they did make for fitting, I was asked to return, which I did. The “second” was never made at all.

All I am asking is for a fair exchange, an ethical exchange, a timely exchange, a legal exchange of value for value given.

But that is not all, I prepaid hundreds of dollars for other procedures, which simply were not done at all, at my request. And they refuse to refund me the balance for those.

Up until now, it could be said they were “just dragging their feet”. But now, based on their responses to your requests of them, they have made false and misleading statements and knowingly and willfully lied. They lied to me over and over again, as I have indicated in my letter. But now they have lied to you.

To make an error is sometimes to be expected, but to continue on with misinformation – either calculated or uncalculated on their part – becomes a pattern of falsehoods. The more this dialogue continues, the more they are forced to lie to support their assertions. And continuing in their lies constitutes fraud.

It is a fraudulent pattern of behavior, from beginning to end. In any case, it defrauded me.

Also, here is my complaint to the Better Business Bureau, to which they did not respond, receiving a bad mark.

COMPLAINT ACTIVITY REPORT Case # 533214 BBB of Los Angeles and Silicon Valley

Consumer Info: Courtney III, Thomas Business Info: West Coast Dental Group of South Gate
1810 Garvey Ave. Unit A 4149 Tweedy Blvd # G
Alhambra, CA 91803 South Gate, CA [protected]
[protected]-1826 [protected]
[protected]@yahoo.com

Location Involved: (Same as above)

Consumer's Original Complaint :

They promised me a credit which they now will not issue. I cannot get a refund for work that was prepaid but not done.

Regarding my experience with West Coast Dental of South Gate. I prepaid $3450 and only had half the work done, but can't seem to get a refund. So much confusion and delay over three months now, that it begins to be dishonest. I was told that on one procedure that cost me $1500 that if I wasn't happy with it, they would credit my account the full amount, and I could do something else. I cancelled it after the first fitting, when I realized I would rather have no teeth in my mouth than this thing. Now I can't get the credit they promised. And I cannot get a refund for work that was prepaid but never done. So I am out about $3000 and have wasted an incredible amount of time. They don't call me back - ever. They forget what they are doing, and it is easy when you have already collected your money.

Consumer's Desired Resolution:

I would seek the $1500 credit they promised me, but I cannot see at this point how I can continue to do business with them. I have lost confidence in them, their procedures, personnel and their basic honesty. So I therefore must request a refund of this amount and a refund for work prepaid but not performed. The total refund is approximately $3000. I do not know the exact amount, as they refuse to settle my account, though I have requested them to do so about 10 times over six months

BBB Processing

01/18/2017 web BBB Case Received by BBB

This is my most recent contact with West Coast Dental.

February 22, 2017

Thomas Courtney III
1810 A Garvey Ave.
Alhambra, CA [protected]

Blue Shield Member # [protected]

West Coast Dental
4149 Tweedy Blvd., Ste. J
South Gate, CA 90280

Dear Sir/Ms:

Thank-you for your response to my grievance filed with Blue Shield.

There are still a number of factors that have not specifically been addressed, that resulted in my being unethically and illegally treated and billed.

Please also note, this is not a matter of “overbilling.” This is a matter of billing for services that were not provided.

You indicated to Blue Shield in your letter of February 2017:

A. “ … before services were rendered I was given different options, and the best choice was for a partial which I accepted.”

This statement is untrue, because I was given false information and aggressively mislead regarding the procedures and their costs. Under those circumstances, how can it be said I “accepted”?

Specifically, I was told by Dr. Shah the two covered benefits in my Blue Shield Dental Plan were inferior, and he advised me to try an uncovered procedure that was “much better”. Other patients who tried it were “very pleased with it”.

The two covered partials were made of a “hard” plastic. The ones he recommended were made of a “softer, better-fitting, more comfortable compound”.

If I tried his recommendation and was not happy with it, we would stop, and West Coast Dental would give me a statement credit for the full amount. Then we would try something else.

He also stated his “credit promise” to me at least twice more, on different occasions, on one occasion adding, “Don’t worry. If you are not happy, we will give you a credit – even if the procedure is completely finished. If you are not happy with it, just say so, and we will try something else.”

In addition, he told me, “If I tried his recommendation, which cost $1500 each (upper and lower partial dentures $3000), he would give me a discount on my other work, in effect, not billing me for the extractions I needed.

And as a note, Dr. Shah’s business card indicated he was “Managing Dentist”. So there shouldn’t be any question about his authority or whether he acted in the name of West Coast Dental.

Reference: ADA Principles of Ethics and Code of Professional Conduct
SECTION 5 — Principle: Veracity ("truthfulness")
5.B.1. Waiver of Copayment. A dentist who accepts a third party payment under a copayment plan as payment in full without disclosing to the third party that the patient's payment portion will not be collected, is engaged in overbilling. The essence of this ethical impropriety is deception and misrepresentation; an overbilling dentist makes it appear to the third party that the charge to the patient for services rendered is higher than it actually is.
It turns out that he made repeated false and misleading statements to me in violation of ADA Principles of Ethics and Code of Professional Conduct:

SECTION 5 — Principle: Veracity ("truthfulness") The dentist has a duty to communicate truthfully.

This principle expresses the concept that professionals have a duty to be honest and trustworthy in their dealings with people. Under this principle, the dentist's primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity.
Code of Professional Conduct
5.A. Representation of Care. Dentists shall not represent the care being rendered to their patients in a false or misleading manner.
You indicated to Blue Shield in your letter of February 2017:

B. “ … there was an issue with the first partial, and as a courtesy, you made a new one, unfortunately you are still unhappy with the new partial …”

This is simply untrue. After I had repeatedly told them to stop …

… I told Dr. Shah, I called and told the receptionist three times, I told Marisol repeatedly, I told the new dentist assigned to me after Dr. Shah left, I told the dental technician who did the pre-dentist workups …

… You simply would not stop. The dental technician came in in a subsequent appointment to make new gel fittings. I asked him, “What is that? What are you doing?’ He responded, “I am taking new fitting.” After he was done, I asked him, “Why are you doing that?” He responded, “To fit your new partials.”

I responded immediately, “I do not want new partials. I have told them that over and over!” He responded, “Well you said, just give us a chance to make them right.” I responded, “No. I do not want partial dentures, period. So please just stop.”

And please note, you say, “… I was not happy with the new partial.” That also is untrue: you never delivered a new partial to me.

You did not make a new partial, and you asked me to return the first partial, the one you did deliver, the one I was unhappy with. Marisol told me to return it, which I did, because she “could not request the statement credit for me if I kept it. You would say it had been delivered, that is, procedure completed and accepted by the patient.”

You indicated to Blue Shield in your letter of February 2017:

C. “ … the dental work was done properly and all services were performed within the dental standards.”

That is an "assertion" on your part and untrue for several reasons: the most you delivered was a first fitting, and you lied about your procedures in order to get me to accept your recommendation. In summary, I paid $3000, for which I got nothing. I have nothing, nothing, for $3000, nothing, zero.

Reference: ADA Principles of Ethics and Code of Professional Conduct
SECTION 5 — Principle: Veracity ("truthfulness")
5.B. Representation of Fees. Dentists shall not represent the fees being charged for providing care in a false or misleading manner.
Blue Shield wrote to me regarding my grievance:

D. “ … we asked them about the credit you requested, but they did not give us any information regarding it.”

That is the same response you have given me – no information. You do not want to address the issue directly. But since everything was prepaid, you were paid in advance, you continue to keep my money for no services performed.

I repeat, for $3000 I have received nothing. I have no partial dentures. The one you did make for fitting, I was asked to return, which I did. The “second” was never made at all.

But that is not all, I prepaid hundreds of dollars for other procedures, which simply were not done at all, at my request. And you refuse to refund me the balance for those.

Up until now, it could be said you were “just dragging your feet”. But now, based on your responses to Blue Shield, you have made false and misleading statements and knowingly and willfully lied. You lied to me over and over again, as I have indicated. But now you have lied to Medicare insurance provider.

To make an error is sometimes to be expected, but to continue on with misinformation – either calculated or uncalculated on your part – becomes a pattern of falsehoods. The more this dialogue continues, the more you are forced to lie to support your assertions. And continuing in your lies constitutes fraud.

You indicate a clearly fraudulent pattern of behavior, from beginning to end. In any case, you defrauded me.

Health care fraud and insurance fraud include the following:

• Billing for services not provided
• Falsifying medical records
• Providing excessive unnecessary procedures

Most Los Angeles health care fraud is charged pursuant to Insurance Code Section 1871.4. In addition, most of these cases also have a Penal Code Section 550 charge. The section is used when the person making the insurance claim makes a false material statement to either obtain, or deny insurance benefits. Because the insurance claim is based upon a false statement the prosecutor will also file a perjury charge pursuant to Penal Code Section 118.

The insurance companies pay investigators to review medical claims to determine if the claims contain any fraud. When the investigator finds fraud, the cases are referred to law enforcement for prosecution. Most of these cases are for billing fraud. Billing fraud may be that a doctor billed for more procedures then actually performed. Dental providers may face prison sentences as well as loss of their license from the California Medical Board.

The punishment for a conviction of health care fraud includes: Imprisonment in state prison or jail, loss of professional license, parole or probation, substantial fines and court costs, restitution that could include all monies collected from insurance agencies, an inability to be a Medicare or Medi-Cal provider in the future.

I acted responsibly and with respect towards everyone at West Coast Dental, I fulfilled my duties and obligations. You lied to me, took my money, and I end up with nothing.

Please refund to me within one week the total balance I prepaid for the work not performed to avoid further complications.

Sincerely,

Thomas Courtney III

Th
Apr 03, 2017

Post your comment