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.

or complete our Online Fraud Complaint Form