Episode 221 | $12 Billion in Dental Fraud: What Every Dental Practice Needs to Know from the Payer Side | Michael Cembrola
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Show Notes
Michael Cembrola spent more than 20 years on the payer side of dental insurance, including six years running the national sales team for Delta Dental of California and all their affiliated states. He has been inside FBI investigations into dental fraud. He has sat in rooms where insurance companies decided which new technologies, they would not cover. And he has watched the gap between carriers and providers quietly damage both sides while patients absorb the cost.
In this episode of The Dental Handoff, Dr. Kelly Tanner sits down with Michael to talk about what fraud looks like from the inside, why most of it is unintentional, and what happens when an honest coding mistake turns into a six-figure fine. Michael is building an AI behavioral fingerprinting tool that detects fraud in one month versus the carrier average of one year. Kelly also tells the story of her first dental job as a 22-year-old baby hygienist, the office manager who tried to pin an embezzlement charge on her, and why not knowing what petty cash was is what saved her.
This conversation is for dental hygienists, dentists, practice owners, office managers, DSOs, and anyone working with dental insurance. If your practice files claims or accepts insurance, this one is directly relevant. Subscribe to The Dental Handoff on Apple Podcasts and Spotify. New episodes every week.
Connect with Michael Cembrola:Company: MJC Growth Advisors | LinkedIn: linkedin.com/in/mikecembrola
Where to Find Dr. Kelly:
Let’s Connect! Book a Call today to see how I can help you create high-performance teams, discuss educational programs, or how I can be of assistance.
https://calendly.com/drkellytanner/30min
Visit us at https://www.nextleveldentalhygiene.com
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