An estimated 3% of the United States’ total spending on health care is caused by fraud, according to the National Health Care Anti-Fraud Association. That may sound like a small percentage, but with dental spending projected to reach $203 billion by 2027, that means we can expect to face over $6 billion in dental fraud.
Dental fraud is “any crime where an individual receives insurance money for filing a false claim, inflating a claim or billing for services not rendered,” according to the American Dental Association (ADA). Fraud can take many forms, but it requires intent, deception and unlawful gain.
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 ADA (PDF) and Delta Dental can help you, and your state’s dental board may have resources as well.
Because fraud requires intent and deception, there are signs that you and your staff can watch out for from patients who commit dental fraud. Stay alert for:
Because fraud can be perpetrated by both patients and care providers, having clear policies can help prevent fraud before it begins. Make sure your practice prohibits the following:
Although fraud requires intent, it’s possible to commit mistakes that could unknowingly get you into trouble. It’s entirely possible to unknowingly commit fraud in an attempt to help patients who might be seeking help with their coverage. For example, waiving coinsurance costs is one example of this. In other cases, it might be a simple oversight. Common mistakes considered fraud include:
Fraud can happen at any point in the process of providing care, accepting payment and submitting claims, but having clear, consistently applied policies for your practice can help everyone play their part in fighting fraud. Here are some general steps your practice can take.
Here are some things you can do every month to help fight 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. What we do includes:
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, having understandable and consistent policies and maintaining good relationships with paying patients, you can help keep your practice in the green and trouble-free.