Erie-area dentist charged with insurance fraud [Erie Times-News, Pa.]

July 16--Police have charged a local dentist with defrauding insurance companies by practicing a scheme in which some of the evidence was buried in his patients' mouths.

Kevin R. Sambuchino is accused of overbilling patients for crown work from January 2006 through January 2009.

Police allege Sambuchino, the owner of Lake Erie Dental, billed patients' insurance companies for dental crowns of a high quality and value but actually installed crowns of a lesser or "non-precious" quality.

"The non-precious crowns were ultimately placed into patient's mouth and their respective insurance carrier (was) billed for a higher-quality product," according to the criminal complaint, filed on Thursday.

Police in the complaint provide no financial figures for the amount of money Sambuchino is accused of obtaining through fraud.

The complaint said investigators considered "hundreds of insurance claims" submitted by Lake Erie Dental to a total of four insurance carriers or administrators. Lake Erie Dental's main office is at 4944 Peach St., Millcreek Township, and its satellite office is at 106 Waterford St., Edinboro. Both remain in business.

Sambuchino, 36, of the 5800 block of Hickory Knoll Court, Fairview Township, is accused of 16 counts of insurance fraud as a third-degree felony, the highest grading for the offense under the Pennsylvania Crimes Code. A conviction for a third-degree felony carries a maximum sentence of seven years.

Police did not take Sambu chino into custody. He is to appear at his arraignment today before Greene Township District Judge Susan Strohmeyer, whose office covers part of Millcreek.

Sambuchino's lawyer, Charles Steele, of Pittsburgh, called the charges "outrageous" and said Sambuchino has retained insurance experts who found nothing illegal about Lake Erie Dental's billing practices.

Steele said any overbillings were due to coding errors related to processing the claims, and that Sambuchino has refunded affected patients. He called the total amount of the refunds insignificant but was not more specific.

"I think we have a strong case for innocence," Steele said. "We have done a good-faith and thorough investigation of this. We believe these charges are completely unfounded.

"These charges are being brought by people who don't understand the practice of dentistry."

He said Sambuchino, D.D.M., a dentist since 2000 and the son of a dentist, would have no comment. Sambuchino was with a patient when the Erie Times-News telephoned his office about the charges on Thursday.

Erie County District Attorney Jack Daneri said state police filed the charges based largely on billing records seized from Lake Erie Dental in 2009.

"We combed through his records," Daneri said. "We believe the charges filed are appropriate."

Daneri's office reviewed the criminal complaint, which was filed by Trooper Eric Rogers, who works with the local office of the federal Bureau of Alcohol, Tobacco, Firearms and Explosives. The ATF can probe allegations of mail fraud, and an ATF agent, Jason Wick, helped on the Sambuchino case, which includes only charges of insurance fraud. The Internal Revenue Service was also involved.

Police filed the charges more than a year after investigators searched Lake Erie Dental's offices on June 3, 2009, looking for billing records. A main witness police used to get information for that search warrant, according to the warrant, was another dentist, Robert N. Halmi, D.D.S., 68, licensed since 1970.

He was in business with Sambuchino at Lake Erie Dental from December 2006 until Halmi resigned in April 2009. The two soon were at odds over financial terms.

Halmi, who now practices with another dentist in Cambridge Springs, sued Lake Erie Dental in Erie County Court in late May 2009, demanding payments that he said Sambuchino owed him. Lake Erie Dental sued Halmi in early June 2009, claiming Halmi forfeited his right to the money because he solicited Lake Erie Dental's patients and violated the noncompete clause -- contentions Halmi denies.

All the civil claims are pending. Halmi declined to comment about Sambuchino's criminal case on Thursday, and referred questions to his lawyer, Philip Friedman, who declined to comment.

In early May 2009, a month before Lake Erie Dental sued him, Halmi met with Wick, the local ATF agent, according to the search warrant. The criminal probe had started.

Police said the insurance companies cooperated. They are United Concordia, MetLife, Delta Dental and Benefit Administrators Inc., or BAI, according to the criminal complaint.

Police in the complaint said investigators spoke to "past and present employees" who worked for Sambuchino, though the complaint does not identify them.

The complaint said investigators also met with a number of local dentists, who are not identified. Police said those dentists all agreed that the billing practices of Sambuchino for the crown work "were not the norm and that the quality of the billed product is what should be placed in the mouth of the patient when the procedure is being performed."

Based on Steele's comments, the defense is likely to try to pick apart the criminal case by focusing on Halmi and other prosecution witnesses who once worked for Lake Erie Dental.

Sambuchino took that approach in August, when he wrote a letter to Lake Erie Dental's patients in response to the ongoing criminal probe.

"Lake Erie Dental will vigorously defend itself against this despicable tactic and false charges," the letter said, referring to Halmi's interactions with investigators.

"No charges have been filed. Lake Erie Dental does not expect any charges will be filed in the future."

ED PALATTELLA can be reached at 870-1813 or by e-mail.

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