When buying a dental practice or bringing on an associate, you’ll often hear bad advice: “Just bill under the seller’s NPI until your credentialing is complete.” It may sound harmless, but this practice is considered insurance fraud — and the risks are far greater than the short-term benefit.
What is NPI Fraud?
– Each dentist has a unique NPI (National Provider Identifier).
– Claims must show the actual provider who delivered care.
– Submitting under another provider’s NPI — even temporarily — is a false claim.
This usually happens during credentialing delays when a new provider isn’t yet in-network. But insurers see it for what it is: misrepresentation.
Real-World Consequences
Regulators and insurers are actively enforcing NPI misuse:
– $125,000 penalty against an Indiana practice for billing Medicaid under the wrong dentist.
– $540,000 settlement with a national group for using in-network NPIs on non-credentialed claims.
– Prison time for a Tennessee dentist who falsified claims to appear credentialed.
Whether it’s a solo office or a corporate chain, the outcome is the same — heavy fines, lost contracts, and damaged reputations.
The Risks You Face
👉 Financial penalties & repayment of claims
👉 Termination of in-network contracts
👉 State board investigations
👉 Loss of licensure in severe cases
👉 Criminal liability and even prison time
How to Protect Your Practice
– Start credentialing early — months before a transition.
– Never bill under another provider’s NPI. If you’re not credentialed, bill out-of-network or wait.
– Train your team so they know “shortcuts” like swapping NPIs are never acceptable.
– Get expert help. At PPO Advisors, we’ve guided hundreds of dentists through credentialing the right way.
Final Word
Insurance fraud doesn’t always look like fraud. Sometimes it’s just following “bad advice.” But the risks — fines, lost contracts, even prison — make it clear: the only safe way forward is compliance.
At PPO Advisors, we’ll help you avoid these pitfalls and credential the right way so you can focus on what matters most: caring for patients and building your practice.