‘Tooth bling’ scam hits medical aids

Shocking fraud involving “tooth bling” has come to light as two reliable sources from the dental industry spoke out this week about widespread corruption surrounding the popular trend of having gold or silver inlays put into teeth as a fashion statement.

Known as “tooth bling”, it appears that some unscrupulous dentists bill medical aids for the cosmetic inlays under the guise of fillings, while the “gold” inlay is not generally made from gold but from cheaper alloys which corrode in the mouth.

Meanwhile, some less-than-honest patients use a friend or family member’s medical aid card to have the “bling” put in,

Neither of the sources were willing to be identified for fear of losing their jobs, but said not only were some dentists working hand in hand with their patients when it came to fraudulently claiming from medical aid for the mouth bling, but that the wrong mix of alloys or using an inferior product can corrode teeth and even impact on the patient’s health.

Gold falls under precious metals and is used in dentistry for fillings and inlays, as well as non-precious metals or alloys such as copper and brass. The danger arises when the alloys are mixed incorrectly or when low-grade products are used.

A recent report on prosthetic dentistry stresses that high levels of metallic trace elements in the body can be harmful or toxic.

“It’s also unethical for a dentist to cut into a perfectly healthy tooth, in fact that borders on illegal. If the inlay is not properly done, the tooth can be damaged to the extent it has to be extracted,” said one of the sources.

The second source said there was a dentist in Phoenix who advertised inlays for R250.

“Look at the price per gram for gold and the labour involved and R250 is just not financially possible.

“Everything has become price-related and a lot of inferior product is being sourced from other countries,” he said.

And while the fraud is costing the medical aid industry billions of rand, both sources said high medical aid costs and the limited dental care on many medical aids has played a role in patients turning to cheaper options.

The Board of Health Care Funders (BHF) and Discovery Health said this week that many different types of fraud were being committed, including the fact that dentists claim for normal crowns, additional fillings or extractions which are not actually done or providing members with cosmetic gold inlays for normal crowns.

Discovery Health chief executive Jonathan Broomberg said that white collar crime, including fraud, was on the rise in South Africa and international trends suggested that millions would be lost to fraudulent medical scheme claims annually.

“There is no doubt that fraud is one of the drivers of escalating medical aid scheme costs in South Africa and that all stakeholders should collaborate to reduce fraud and bring the perpetrators to book,” said Broomberg.

BHF spokesperson Heidi Kruger said medical aid fraud which involves collaboration between medical practitioners and medical aid members was very difficult to fight.

“We rely on tip-offs and also try to spot patterns in the medical aid claims,” said Kruger.

The Independent on Saturday spoke to five people who admitted that they had claimed for their silver and gold inlays through medical aid.

According to people interviewed, the trendy tooth can cost anywhere between R1 000 to R2 500, and there is even talk of a new “platinum tooth” although this could not be confirmed.

Sindiswa Mthembu*, 32, from Umlazi said she had used her medical aid to pay for her own L-shaped gold inlay as well as her 21-year-old sister’s silver inlay. “Usually you have to look around and find out from a person who has a gold tooth, which dentists are prepared to do it. You can’t just go to any dentist,” said Mthembu.

Patience Ndlovu*, 22, from Chesterville said she had her front silver teeth done at the age of 16, but decided to get rid of it recently as she feared that it would create a bad first impression at job interviews.

Sizwe Mlambo* from KwaMakhutha has a total of three inlays, two silver and one gold which he paid for with his Discovery Medical Aid.

“I think it costs about R2 300 on medical aid per tooth, but if you had to pay cash it would cost less – around R1 200,” said Mlambo.

Khulekani Zulu*, 21, from Seaview, said he liked the idea of having gold on his teeth when he was only six years old. “My aunt had one and I wanted one too,” said Zulu.

He managed to get an older relative with a medical aid to fund his new look when he was 16 years old.

Zulu now has a full gold inlay and an L-shaped gold inlay as well. “It’s very popular here in Durban, almost half my friends have it done,” he said.

A dental technician who did not want to be named said a gold inlay was usually done by cutting a piece of a person’s tooth and then replacing it with silver or gold.

“The most expensive type of crown requested is the one containing 20 carat gold, the cheaper version contains between 14 to 18 carats of gold,” he said.

*Not their real names