Mass. Man Faces Insurance Fraud Charges Over Broken Tooth Claims

A Massachusetts man has been arraigned in Suffolk Superior Court in connection with allegedly submitting false dental injury reports to insurance companies in order to receive cash settlements.

Tod Schaffer, 42, is charged with 19 counts of insurance fraud, 10 counts of larceny over $250 and 11 counts of attempted larceny over $250

In May 2007, the Attorney General’s Office began an investigation after the matter had been referred by the Massachusetts Insurance Fraud Bureau (IFB). In October 2002, Schaffer legitimately injured a tooth by biting into a piece of plastic in his salad at a local restaurant. Schaffer received treatment for the injury from his dentist, and
received an estimate for the cost of treating the injury. Schaffer then submitted the dental estimate to the restaurant where the injury occurred, and ultimately received full payment for his injury a week later.

The IFB was initially notified by an investigator for the Great American Insurance Co., who discovered that several restaurant claims for the same broken tooth all contained identical personal information allegedly belonging to Schaffer. Investigators discovered that on various dates between November 2002 and May
2006, Schaffer allegedly submitted 19 false injury claims to insurance companies, and two additional claims to a selfinsured
entity.

Authorities believe that these false claims allegedly contained the same information from Schaffer’s legitimate tooth injury claim from October 2002. Investigators discovered that Schaffer allegedly altered the manner in which the injury occurred on these false claims by reporting that he injured his tooth by biting into a rock, a stone,
or plastic, while eating at numerous Boston area restaurants.

Of the false claims submitted by Schaffer, 10 of them were paid out, resulting in over $36,000 in false payments to Schaffer. Investigators also discovered that Schaffer allegedly withdrew his claims at nine restaurants, and that an additional two restaurants denied his claim.

A Suffolk County Grand Jury returned indictments against Schaffer on Jan. 22, 2009. He is scheduled to appear in Suffolk Superior Court on May 11, 2009, for a pre-trial conference.

The case is being prosecuted by Assistant Attorney General Jennifer Cotter of Attorney General Martha Coakley’s Insurance and Unemployment Fraud Division and was investigated by the Massachusetts Insurance Fraud Bureau.

Source: Massachusetts Attorney General’s Office