San Diego dentist sentenced in nearly $900,000 fraudulent billings scheme
News: 2020 Press Release
SAN DIEGO, Calif. — General dentist, April Rose Ambrosio, 59, of Mira Mesa, was sentenced today to six years in prison after pleading guilty to three counts of insurance fraud for falsely claiming she performed 800 root canals on 100 patients in four years though she lacks the specialized training required of an endodontist to perform root canals. Ambrosio fraudulently billed multiple insurance companies nearly $900,000 to receive more than $400,000. In some cases, her alleged patients never set foot inside her office. She was ordered to pay restitution in the amount of $405,633.
“This medical provider abused the trust placed in her by fraudulently billing for procedures she never performed and was never trained to perform,” said Insurance Commissioner Ricardo Lara. “Her illegal actions cost California consumers through higher insurance premiums and erodes the trust consumers hold for honest providers in the dentistry field. Thanks to the great teamwork by Department of Insurance detectives and the San Diego County District Attorney's Office, we were able to stop this scheme and send a clear message that this fraudulent behavior will not be tolerated.”
A two-year investigation by the Department of Insurance, working closely with the San Diego County District Attorney’s Insurance Fraud Division, revealed from 2014 to 2018, Ambrosio fraudulently billed 10 insurance companies $866,700 for 800 root canals for 100 patients, which were never performed.
To facilitate her scheme, Ambrosio billed for work on days her office was closed or she claimed to be on vacation. For one family of four, she billed the insurance companies for more than 100 root canals over a three-month period. Ambrosio also billed for root canals performed on non-existent or missing teeth, or double billed for teeth she previously claimed to have performed root canals on.
Ambrosio never directly billed her patients for their portion of the phony dental work, which she billed to the insurance companies and resulted in a loss of over $400,000 to those companies. Ambrosio’s license to practice dentistry was suspended on September 24, 2019.
The San Diego County District Attorney’s Office prosecuted this case.
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Led by Insurance Commissioner Ricardo Lara, the California Department of Insurance is the consumer protection agency for the nation's largest insurance marketplace and safeguards all of the state’s consumers by fairly regulating the insurance industry. Under the Commissioner’s direction, the Department uses its authority to protect Californians from insurance rates that are excessive, inadequate, or unfairly discriminatory, oversee insurer solvency to pay claims, set standards for agents and broker licensing, perform market conduct reviews of insurance companies, resolve consumer complaints, and investigate and prosecute insurance fraud. Consumers are urged to call 1-800-927-4357 with any questions or contact us at www.insurance.ca.gov via webform or online chat. Non-media inquiries should be directed to the Consumer Hotline at 800-927-4357. Teletypewriter (TTY), please dial 800-482-4833.