Have you ever waived a copayment after a patient asked you to or unbundled procedure codes because you couldn’t find the one you were looking for? Depending on the circumstances, you could be considered negligent or even convicted of fraud.
Dental insurance 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.
Fraud can take many forms, but it requires intent, deception and unlawful gain. It is possible to unintentionally take action that could get you into trouble — but what differentiates fraud from negligence is intent. For example, purposefully misrepresenting information in a claim so that you, your practice or your patients receive more money is considered fraud.
There are many billing and claims habits that are fraudulent. The most common types of billing fraud are:
If you suspect fraud has been committed, you can call the Delta Dental Anti-Fraud Hotline at 800-526-1852 or submit our online form for reporting potential fraudulent activity. You may choose to stay anonymous when you report fraud.
After receiving reports of suspicious activity, Delta Dental will investigate. We use tips, reports and utilization analysis to look for unusual patterns that may indicate fraud and we may work with law enforcement if needed.
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 network participation and professional licenses and even jail time.
For more information about fraud, visit Delta Dental’s fraud and abuse resources.