On October 22nd, 2020

San Diego Dentist Sentenced in Fraudulent Billing Scheme Falsely claimed she performed 800 root canals on 100 patients over four years

SAN DIEGO— General dentist, April Rose Ambrosio, 59, of Mira Mesa, was sentenced on October 21, 2020 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.

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.

“California Department of Insurance detectives investigate health professionals, among others, who are suspected of committing insurance fraud, which is not a victimless crime,” said California Statewide Law Enforcement Association (CSLEA) President Alan Barcelona.   “We all pay higher premiums because of the amount insurers lose to fraudulent activity.  Thank you to Department of Insurance detectives for their constant work in pursuing those who try to profit but submitting false claims.”

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.

Insurance Commissioner Ricardo Lara said, “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.”

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