The Department of Insurance worked with the San Diego County District Attorney’s Insurance Fraud Division to investigate 800 root canal claims alleged to have taken place from 2014 to 2018 by General Dentist April Rose Ambrosio, 59, of Mira Mesa.
Over two years, what was discovered was Ambrosio billed 10 insurance companies for 800 root canals performed on 100 patients, none of which took place. Some of the patients she submitted claims for never visited her office. She submitted claims for root canals on teeth that did not exist or were missing, and over a three-month period, submitted claims to multiple insurance companies reporting to have performed over 100 root canals on a family of four.
Additionally, Ambrosio did not possess the specialized training of an endodontist to perform root canals.
Ambrosio never billed the patients, always insurance companies, for the non-existing work. All in all, she billed for almost $900,000 of which she was paid $400,000. On September 24, 2019, her license to practice dentistry was suspended. On October 29, 2020, she pled guilty to three counts of insurance fraud and was sentenced to six years in prison. She will also have to pay a restitution amount of $405,633.
About this case, Insurance Commissioner Ricardo Lara sated, “This medical provider abused the trust placed in her by fraudulently billing for procedures she never performed and was never trained to perform. 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 Attorneys Office, we were able to stop this scheme and send a clear message that this fraudulent behavior will not be tolerated.”