Dentist charged, patients left to pay

CRANSTON, R.I. (WPRI) - A Cumberland woman says she's the victim of fraud.

Her Cranston dentist was recently arrested and charged with insurance fraud. Now she gets a bill for work that was never done.

Christine Payson and her husband had been patients of Dr. David Marcantonio's for years. Then, back on March 20th, 2008, they received a letter from Delta Dental stating that the insurance company would no longer be paying for service done by Marcantonio due to quality of care issues.

David said, "I couldn't believe it because we've been going there regularly. So as far as we knew everything was on the up and up."

The Paysons switched dentists. They thought that was the end of it until this past spring when Christine's new dentist said she needed a crown and submitted the paperwork into Delta Dental but it was denied.

According to Delta Dentals records Dr. Marcantonio in August 2005 had put one Christine's tooth.

Reporter asks: Did you ever get a crown?
Christine: Not on that tooth no!

Christine has the x-ray to prove it. Her new dentist says based on the x-ray, along with an oral exam there was no evidence of a crown on tooth.

The insurance company only pays for one crown per tooth every five years, so they would not pay for the work. The Paysons say they tried to explain to the insurer that Christine never had the work done in the first place.

Delta Dental responded:

"Since we no longer have a relationship with Dr. Marcantonio, we cannot compel him to work with us to resolve your issues."

Eyewitness News contacted Delta Dental. The company did reopen the Payson's case. They have agreed to pay for half of the bill for Christine's crown. The company also filed a lawsuit against Marcantonio and if successful in recovering any money, they will make it available to patients who had to incur additional expenses for dental treatment that had to be re-done.

A spokesperson for Delta Dental released the following statement:

“While we cannot comment on an individual patient, Delta Dental of Rhode Island takes provider fraud and quality of care issues very seriously. We have filed suit against Dr. Marcantonio for fraud and filing under false pretenses. We notified the RI Department of Health, the RI State Police and Dr. Marcantonio’s patients early on in this process. We continue to cooperate with the State Police in their criminal investigation, and we intend to vigorously pursue every available avenue on behalf of our members

According to state police, Marcantonio is charged with filing at least 34 fraudulent claims with Delta Dental worth $33,000 dollars. His dental license in Rhode Island has been revoked.