Examples of Dental Insurance 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. Fraud is sometimes called the "hidden" crime because we are all victims without even knowing it.
Dental fraud takes many forms. Examples include:
- Billing for services not provided.
- Reporting a higher level of dental service than was actually performed. This is often called "upcoding".
- Submitting a dental claim under one patient's name when services were actually provided to another person.
- Altering claim forms and dental records.
- Billing for non-covered services as if they were covered services.
- Changing the date of service on a claim form so it falls within a patient's benefit period.
- Routine waiver of a patient's copayment or deductible, if applicable.
- Performing services that are not suitable or necessary.
Still not sure if something is fraud? Give the Special Investigations Unit (SIU) a call at our toll-free number.
1-877-968-7455
or complete our Online Fraud Complaint Form
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