10. The Crowns That Arent There
The Crowns That Aren't There
Here is how you find a fraud with a dental mirror.
You sit a person down. You take their history, and their history includes the sentence "and then I went to Luminous," which by the middle of October was a sentence people said the way you'd say and then I was in a minor accident.
You take their treatment plan out of their hand — they all kept them; they're beautiful documents, people keep them — and you read it, and you photograph it, and then you put the plan face-down on the counter, because you do not want to be looking at it while you look in a mouth.
That was Anh's rule and it was a good one.
You look, then you compare. Never the other way round.
And then you look.
It took six Saturdays and by the end of it I could have told you the pattern in my sleep, because a fraud is like a hand: once you've seen the technique you see it everywhere.
They billed three things. Crowns — the big ticket, fifteen hundred, two thousand each depending on the code.
Onlays, which are a smaller crown and a code most people have never heard of.
And soft-tissue grafts, which are expensive, which hurt, and which — this is the clever part — which look, in the mouth, six months later, like nothing at all, because a successful graft is supposed to be invisible.
Some of it was done. That's what made it survivable for so long.
Maybe a third of the work billed had actually been performed, and performed competently, because Preston Hale was a genuinely good dentist and there were two other associates in that building who were, as far as anyone has ever established, entirely innocent and simply doing the cases put in front of them.
But two-thirds of it wasn't there.
Mrs. Yolanda Frame, sixty-one, retired county clerk. Billed for four crowns, upper left quadrant, in September. In her mouth: four unrestored teeth, sound, unprepped, with the original enamel and the original anatomy, and a small composite from 1998 that Walt Ostrander placed.
Danny Obregón's brother-in-law, Ruben, thirty-nine. Billed for two onlays and a graft. In his mouth: nothing. Not a thing. He had, on the day of his "graft," been in that building for one hour and forty minutes and had come out numb, which he reported proudly as proof that something had happened.
That one kept me up.
"They numbed him," I said to Anh, on the third Saturday, in the sterilization room, with the door shut.
"To sell the visit."
"To sell the *sensation* of the visit. He went home numb and sore and grateful and he told his brother-in-law it was great.
" I had my hands braced on the counter. "Anh, that's not billing fraud.
Billing fraud is a bookkeeper and a code.
Somebody sat that man down and put a needle in his gum for no clinical reason on purpose, so that he'd feel like he'd had surgery. "
Anh Trinh, who is twenty-nine and who I would now hire nine times out of ten over any dentist I know, said: "That's assault."
"Yes."
"Who does the injection? An assistant can't. Not a block."
And there it was. That was the question that cracked it, and a twenty-nine-year-old associate asked it in a sterilization room on a Saturday in October.
Because in California, a dental assistant cannot administer a local anesthetic block.
A registered dental assistant in extended functions can do a great deal, but not that.
It's a dentist, or in some circumstances a hygienist with a permit — and Luminous, as Marisol had noticed on opening night with a glass of prosecco in her hand, did not employ a single hygienist.
"So it's a dentist," I said. "Every fake visit has a dentist in the room, with a syringe, doing nothing."
"Or," said Anh, "it's someone pretending to be one."
By the sixth Saturday the list in the locked drawer had fourteen names on it, then nineteen, then twenty-three.
We had photographs. We had the plans, face-down and then face-up.
We had, because Marisol insisted from the first day and drafted the form herself on a Tuesday night, a signed release from every single patient authorizing release of their records and their images to "any investigating authority, state or federal" — which meant that when it eventually went where it went, none of it had to be thrown out.
I have said that Marisol Vega runs my practice. What I mean is that Marisol Vega ran that investigation, and the state dental board's eventual case, and about forty percent of a federal indictment, off a legal pad and a locked drawer, while also doing all four of her actual jobs.
And on the fourth Saturday, a woman named Robin Salas sat in chair two and said, while I was counting what wasn't in her mouth: "It's funny you're doing this. The other doctor asked me the same thing."
I stopped with the mirror halfway out.
"Which doctor?"
"Dr. Hale. In the summer." She shrugged.
"He came in at the end, like he does — did — and he looked at my chart on the screen and then he looked in my mouth and then he looked at the screen again for a long time.
And he asked me, real quiet, 'Robin, who did your upper right?
' And I said, well, you did, in June. And he just said 'right' and smiled and that was it.
" She frowned at the ceiling, at the sea otter.
"I thought it was strange because it was on his own screen, you know? It was his own chart."
I sat back on my stool.
"Robin," I said. "When was that?"
"End of July."
Ten days after that, Preston Hale had started refusing to sign off on treatment plans.
I didn't know that yet. But I knew, sitting on a stool in my own operatory on the fourth Saturday in October, that the man I had shouted at in front of a hundred and forty people had been looking in mouths and finding nothing in them, in his own building, in his own chairs, on his own charts, two months before he died.
You think I don't know what's going on in my own building?
He hadn't been threatening me. He'd been asking me for help.