Molen Orthodontics

COMPLAINT RCW 48.80 Health Care False Claim Act RCW 9.45.100 Fraud in assignment for benefit of creditors RCW 9A.28.040 Criminal conspiracy Complaint against: Molen Orthodontics Financial Specialist Kirsten Joy Juth Complaint against: Kelli Lynn Hamilton the insured (Delta Dental) March 28, 2022 HEALTHCARE FACILITY: Molen Orthodontics 1110 Harvey Rd. Auburn, WA 98002 253-939-**** UBI #: 600 17* *** RICHARD L MOLEN DDS # DE00008621 HEALTHCARE PROVIDER: Kirsten Joy Juth Financial Specialist Molen Orthodontics DOB: September 2, 1966 ADDRESS: 5852 Marshall Place SE Auburn, WA. 98092 INSURED PERSON: Kelli Lynn Hamilton DOB: April 1, 1970 SSN: 542-11-**** ADDRESS: 16807 SE 354th Pl Auburn, WA. 98092 650-302-**** INSURANCE COMPANY: Delta Dental COMPLAINANT: [Redacted] [Redacted] [Redacted] PATIENT NAME: [Redacted] [Redacted] [Redacted] RELATIONSHIP TO PATIENT: Father DATES: January 2022 March 2022 COMPLAINT NARRATIVE: My name is [Redacted]. My child, [Redacted] (Age 12) is a patient of Molen Orthodontics. I enjoy full legal custody of my child. Per Washington State Superior Court Order, I am financially responsible for 20% of all out of pocket uninsured medical expenses incurred for my child. Kelli Lynn Hamilton is my daughters mother. Ms. Hamilton is financially responsible for 80% of all out of pocket uninsured medical expenses incurred for our child. On 12-15-21 Kelli Hamilton, sent to me via email the attached Molen Orthodontics Orthodontic Treatment Payment Options Payment Plan Option sheet dated 12-09-21 (the payment plan). This payment plan estimated an out-of-pocket payment in full for $8,980.00 to Molen Orthodontics for our daughters braces. The payment plan listed a 5% cash discount and an estimated insurance benefit of $0.00 for a total patient investment of $8,531.00 if the total due was paid by cash or via credit card. A true and correct copy of the payment plan is attached to this complaint. On 01-19-22 my daughter began her treatment plan with Molen Orthodontics. On 02-2-22 Kelli Hamilton sent me an email message demanding to know when I was going to pay Molen Orthodontics my (fathers) 20% obligation for unreimbursed out of pocket medical expenses for our daughters braces. Mrs. Hamilton claimed my 20% obligation was outlined in the 12-09-21 payment plan based on a total of $8,531.00 which was to be paid directly to Molen Orthodontics. My 20% obligation based on a total cost of $8,531.00 was $1706.20. On 02-03-22 I telephoned Molen Orthodontics Treatment Coordinator Alissa @ (253) 735-**** to confirm what total treatment plan cost was due for my daughters treatment after insurance, and after the application of any cash discounts. Alissa was not available and I left a voice message. Less than an hour later I received a return telephone call from Molen Orthodontics Finance Specialist Kristen Joy Juth. After a brief discussion, Mrs. Juth explained to me she was aware of the provisions of the Washington State child support order regarding unreimbursed out of pocket medical expenses for my daughter, my (fathers) obligation to pay 20% of unreimbursed out of pocket medical expenses, and that my 20% obligation was 20% of $8,531.00 for a total of $1706.20 if paid via check or credit card directly to Molen Orthodontics. Mrs. Juth explained this $1706.20 total represented 20% (after 5% cash discount) of the 12-09-21 payment plan quote of $8,531.00 for unreimbursed out of pocket medical expenses for my daughters braces. I inquired of Mrs. Juth if Kelli Hamilton was paying Option 1 or Option 2 of the payment plan. Mrs. Juth claimed she could not discuss Mrs. Hamiltons payments or her financial agreement. I inquired of Mrs. Juth if Kelli Hamilton was being reimbursed via medical or dental insurance for any portion of the total cost ($8,531.00) outlined in the 12-09-21 payment plan. Mrs. Juth claimed she could not discuss Mrs. Hamiltons payments or her financial agreement. I inquired of Mrs. Juth how she calculated the my (fathers) unreimbursed out of pocket medical expense obligation to be $1706.20 or 20% of $8,531.00 and if Ms. Hamilton was applying insurance to some or all of the total $8,531.00 outlined in the 12-09-21 payment plan. Mrs. Juth repeatedly insisted that while she could not discuss Ms. Hamiltons payment option or insurance if any, that my (fathers) unreimbursed out of pocket medical expense obligation was $1706.20 or 20% of $8,531.00. Mrs. Juth invited me to pay $1706.20 via credit card over the phone explaining I would receive the 5% cash discount if I paid my 20% support obligation in total that day. After some discussion and argument regarding if Mrs. Juths $1706.20 quote in fact represented 20% of UNREIMBURSED out of pocket medical expenses for my daughters Orthodontic treatment at Molen Orthodontics, Mrs. Juth insisted multiple times that $1706.20 represented my 20% obligation for UNREIMBURSED out of pocket medical expenses. Mrs. Juth again invited me to pay $1706.20 via credit card over the phone explaining I would receive the 5% cash discount if I paid my 20% support obligation in total that day. I declined to pay the $1706.20 solicited by Mrs. Juth and I informed Mrs. Juth I would follow up with Ms. Hamilton to verify that my (fathers) unreimbursed out of pocket medical expense support obligation was in fact $1706.20 or 20% of $8,531.00. After the telephone call with Mrs. Juth, I sent Ms. Hamilton an email on 02-03-2022 inquiring as to which option Ms. Hamilton chose for payment outlined in the 12-09-21 Molen Orthodontics payment plan. The next day on 02-04-2022 Kelli Hamilton forwarded to me an email containing Delta Dental insurance coverage that Ms. Hamilton was applying to the 12-09-21 payment plan total as well as an email communication from Molen Orthodontics Finance Specialist Kristen Joy Juth. A copy of Ms. Hamiltons 02-04-2022 email is attached to this complaint. In her email communication to Ms. Hamilton, Mrs. Juth explains the application of $2000.00 from Ms. Hamiltons Delta Dental insurance coverage as well as the fathers true 20% unreimbursed out of pocket medical expense obligation of $1306.20 not $1706.20. This $1306.20 is $400 less than the $1706.20 Ms. Juth attempted to solicit from me just 24 hours earlier. Mrs. Juths 02-04-2022 quote of $1306.20 for the fathers true 20% unreimbursed out of pocket medical expense obligation to the mother Kelli Hamilton was $400.00 less than the quote ($1706.20) Mrs. Juth provided to me as health care payer less than 24 hours prior. Molen Orthodontics Finance Specialist Kristen Joy Juth was fully aware Kelli Hamilton was applying a $2000.00 insurance benefit to the payment plan of our daughters braces with Molen Orthodontics but chose to intentionally conceal this fact from me even after I inquired about it. Molen Orthodontics Finance Specialist Kristen Joy Juth falsely insisted on multiple occasions on my 02-03-2022 telephone call with her that my (fathers) unreimbursed out of pocket medical expense obligation was $1706.20 or 20% of $8,531.00. However, this was not true and Ms. Juth knew this not to be true. Ms. Juth knew at the time her quote of $1706.20 was $400.00 more than I was obligated to pay. Molen Orthodontics Finance Specialist Kristen Joy Juth attempted to collect from me over $400.00 more than my Washington State 20% support obligation for unreimbursed out of pocket medical expenses in relation to my daughters braces. On 02-12-2022 I mailed to Molen Orthodontics a Cashiers Check # 003034**** in the amount of $1306.20 representing payment in full of my (fathers) new 20% out of pocket medical (orthodontics) expense obligation. A copy of the receipt of this payment is attached. Note: it is unknown if this payment represents a true and correct 20% of unreimbursed out of pocket medical expenses for my daughters Molen Orthodontics treatment. COMPLAINT KRISTEN JOY JUTH AND KELLI LYNN HAMILTON VIOLATIONS OF THE HEALTH CARE FALSE CLAIM ACT RCW 48.80.030(1) A person shall not make or present or cause to be made or presented to a health care payer a claim for a health care payment knowing the claim to be false. Kristen Joy Juth, Molen Orthodonics Financial Specialist, a person, knowingly presented a false claim for health care payment of $1706.20 to me, a health care payer, multiple times on 02-04-2022. Kelli Lynn Hamilton, insured by Delta Dental, a person, knowingly presented a false claim for health care payment of $1706.20 to me, a health care payer, multiple times on 02-02-2022. RCW 48.80.030(3) No person shall knowingly make a false statement or false representation of a material fact to a health care payer for use in determining rights to a health care payment. Each claim that violates this subsection shall constitute a separate violation. Kristen Joy Juth, Molen Orthodontics Financial Specialist, a person, knowingly made false statements and made false representations of material fact that my financial payment obligation was $1706.20, to me, a health care payer, multiple times via telephone on 02-04-2022, when in fact my actual financial obligation was $1306.20. Kelli Lynn Hamilton, a person, insured by Delta Dental, knowingly presented a false claim for health care payment of $1706.20 to me, a health care payer, multiple times on 02-02-2022. RCW 48.80.030(4) No person shall conceal the occurrence of any event affecting his or her initial or continued right under a contract, certificate, or policy of insurance to have a payment made by a health care payer for a specified health care service. A person shall not conceal or fail to disclose any information with intent to obtain a health care payment to which the person or any other person is not entitled, or to obtain a health care payment in an amount greater than that which the person or any other person is entitled. Kristen Joy Juth, Molen Orthodontics Financial Specialist, a person, knowingly concealed and failed to disclose requested health care payer financial information with the intent to obtain a health care payment to which Molen Orthodontics was not entitled in an amount greater than that which Molen Orthodontics or Kelli Lynn Hamilton was entitled. Kelli Lynn Hamilton, a person, insured by Delta Dental, knowingly concealed and failed to disclose requested health care payer financial information with the intent to obtain a health care payment to which Molen Orthodontics was not entitled in an amount greater than that which Molen Orthodontics or Kelli Lynn Hamilton was entitled. COMPLAINT KRISTEN JOY JUTH AND KELLI LYNN HAMILTON VIOLATIONS OF RCW 9A.28.040 Criminal Conspiracy VIOLATIONS OF RCW 9.45.100 - Fraud in assignment for benefit of creditors. Upon information and belief Kristen Joy Juth, Molen Orthodontics Financial Specialist a person, and Kelli Lynn Hamilton, insured by Delta Dental, a person, knowingly engaged in a criminal conspiracy to defraud a health care payer per RCW 9A.28.040 and RCW 9.45.100 in the amount of $400.00 in an illegal scheme to unjustly enrich Kelly Lynn Hamilton. REQUEST FOR INVESTIGATION AND REFERRAL FOR PROSECUTION On 02-28-2022 I sent to Molen Orthodontics management via certified USPS Mail a formal letter of complaint including a request for an investigation and a request for written confirmation my payment of $1306.20 represents a true and accurate 20% cost for unreimbursed out of pocket medical expenses for my daughters treatment. My certified letter to Molen Orthodontics management was received by Molen Orthodontics on 03-01-2022 and signed for by Molen Orthodontics employee Bridgette DeFrance. My 02-28-2022 letter to Molen Orthodontics management is attached to this complaint. Molen Orthodontics management did not respond to my complaint. Nor did Molen Orthodontics management confirm $1306.20 represents a true and accurate 20% cost for unreimbursed out of pocket medical expenses for my daughters treatment. I formally request an investigation into this matter and into the false representations of Kristen Joy Juth and Kelli Lynn Hamilton under RCW 48.80 The Health Care False Claim Act, RCW 9.45.100 Fraud in assignment for benefit of creditors, and RCW 9A.28.040 Criminal conspiracy as well as any other law applicable to false representations to a health care payer. I also formally request an order or directive to compel Molen Orthodontics to confirm the true and correct total cost for unreimbursed out of pocket medical expenses for my daughters treatment. Thank you. Sincerely, [Redacted]