Newtown Square Dentist Hit With Felonies For Insurance Fraud: DA

NEWTOWN SQUARE, PA — A Newtown Square dentist has been arrested and charged with fraud and related crimes after allegedly filing bogus insurance claims for work that was never done to cover costs.

District Attorney Katayoun M. Copeland announced the arrest of Dr. Simon W. Yoon, 52, a Newtown Square dentist.

Yoon has been charged with 12 counts of insurance fraud, theft by deception, and criminal use of a communication facility, all felonies of the third degree.

He is accused of submitting fraudulent insurance claims for dental work that was never performed in order to cover the costs of procedures such bridges, implants and other dental procedures not covered through insurance.

Yoon, of Yoon Dental Association located at 3400 West Chester Pike in Newtown Square, surrendered to authorities and was released on $25,000 unsecured bail. His preliminary hearing is scheduled for Feb. 21.

In August 2018, CID Detective Christopher Sponaugle received information from Natasha Stroup, fraud investigator for United Concordia Dental, regarding Yoon, according to the DA's office.

Initial investigative findings indicated that Yoon committed fraud against United Concordia Dental by intentionally reporting dental procedures that were not rendered in order to waive patient copays, the DA's office said.

According to the initial investigation, United Concordia Dental’s Utilization Review Department sent two letters to Yoon requesting patient clinical records and radiographs for services purportedly rendered between April 1, 2016 and April 17, 2018 that were suspected as fraudulent.

The DA's office said Yoon provided a significantly delayed response to the letters in June 2018, and sent a letter admitting that he submitted false claims, while also stating, "Some of the patients asked me not to charge their copays, because their previous dentists didn't charge it. I couldn't say no. Instead of charging copays, I did false claims to cover their copays. I knew it was wrong, but I couldn't ask for the copays."

An investigation into the fraud was launched by the Delaware County District Attorney’s Office CID Insurance Fraud Unit, according to the DA's office.

CID Detective Sponaugle and Detective Edward Kazlo met with Yoon at his office in Newtown Square and reviewed the dental records, the DA's office said.

Yoon told them some procedures that were performed on patients would not be covered by United Concordia Dental, and that he would submit fraudulent procedures, that were not performed on the patients, to cover the procedures and copays that that were performed on the patients, the DA's office said.

Yoon explained that United Concordia dental would not question root canal procedures, requesting x-rays or additional information, so he submitted these types of claims to cover bridges, implants and other dental procedures that are not covered by insurance, according to the DA's office.

The total amount of theft committed by Yoon as a result of fraudulent claims he submitted to Concordia Dental was calculated at $9,239, the DA's office said.

If you suspect someone is committing insurance fraud, please contact the Delaware County District Attorney’s CID Insurance Fraud Unit at (610) 891-4126.

Image via Delaware County District Attorney's Office