FYI

Updated: August 2026

Between 3% and 10% of annual health care expenditures in the United States are fraudulent, according to the National Health Care Anti-Fraud Association. Those may seem like small numbers, but dental spending is projected to reach $230 billion by 2030. With even the most conservative estimates, we can expect to face over $6.9 billion in medical fraud in 2030.
 

What is medical fraud?

Fraud can take many forms but requires intent, deception and unlawful gain. Some examples of medical fraud are receiving insurance money for intentionally filing a false claim, inflating a claim or billing for services not rendered.

Fraud harms everyone in the dental industry. It not only drives up the cost of coverage for patients and employers, but it can also directly affect your practice. Being found guilty of perpetrating fraud can result in fines, loss of professional licenses and even jail time.

Educate yourself and your staff on how to stay on the right side of the law. The American Dental Association (ADA) and Delta Dental can help you, and your state’s dental board may also have resources.
 

Common signs of fraud

Because fraud requires intent and deception, there are signs that you and your staff can be on the lookout for:

• Patients who use another person’s ID or multiple IDs to obtain benefits
• Patients who request that you misreport dates to circumvent calendar year maximums or limitations
• Patients who misrepresent their available coverage or ask you to misrepresent care to their insurance (including concealing dual coverage)

Although fraud requires intent, conduct that begins as a mistake or oversight can trigger allegations or investigations of fraud. Even actions taken with the goal of helping patients can create compliance concerns, be a breach of contract, and/or instigate fraud investigations. For example, waiving patient coinsurance obligations or submitting inaccurate claim information may lead to scrutiny.

Examples include:

• Listing the wrong treating dentist on a claim.
• Using an incorrect procedure code.
• Reporting or altering dates of service.

How you can protect your practice

Fraud can happen at any point in the process of providing care, accepting payment or submitting claims. Having clear, consistently applied policies for your practice can help everyone play their part in fighting fraud.

Your practice can take some easy steps to prevent fraud:

• Make payment arrangements with patients before providing services. This includes discussing coverage and fees, especially for optional and non-covered services, so that patients understand their financial obligations, making fraudulent practices less of a concern.
• Discontinue relationships with patients who don’t make reasonable efforts to pay.
• Write a fraud policy with examples. Make sure that your office staff reads and signs the policy.
• Divide tasks related to processing payments between multiple staff members. If one staff member accepts payments, another should make the adjustments in patient records.
• Practice owners should review their practice’s submitted claims. Claims are legal documents submitted with your authorization. The dentist is legally responsible for the accuracy and honesty of a claim, even if another staff member submitted it.

You can also implement these monthly procedures to help fight fraud:

• Review collection and production reports each month. Make sure your bank statement and your office records are aligned.
• Send monthly notices to remind patients of their active balances.
• Forward large uncollected balances to a professional collections agency.
• Check the percentages on your monthly profit and loss records. If supplies cost 8% of your income last year and you’re spending 10% this year, find out why.

What Delta Dental does to help prevent fraud

You don’t have to combat fraud on your own. We’re proud to be your partners in working to eliminate fraud at all levels and steps of the dental care process.

Delta Dental is committed to:

• Educating our clients, members, dentists and employees about fraud detection and prevention
• Reviewing provided services to ensure they meet professional standards
• Reviewing financial and treatment records
• Reporting potential cases to state and federal law enforcement and cooperating with investigations
• Pursuing the recovery of funds when fraud is suspected
• Terminating contracts when fraud is confirmed

If you suspect someone is committing fraud, report it. Call Delta Dental’s Anti-Fraud Hotline at 800-526-1852. You may remain anonymous during this call.

By making sure that you and your staff stay on top of the law, have consistent policies and maintain good relationships with paying patients, you can help keep your practice in the green and trouble-free.