Protecting Our Customers

Protecting our customers - It's why United Concordia targets dental fraud

United Concordia is committed to its members, the dental community and customers not to ignore fraud. Ignoring fraud results in higher insurance premiums. It is United Concordia's goal to ensure that our networks enroll dentists who value the patients' welfare.

The United States General Accounting Office reports that health care fraud adds at least 10 percent annually to the nation's health care costs. In an effort to curb fraud, we monitor all claim submissions received and rely on various tools to uncover questionable reporting, over-utilization and potential fraud schemes.

So what happens if fraud is suspected?

Once United Concordia's Special Investigations Unit (SIU) targets an alleged fraud scheme, we collect reliable evidence to determine investigative merit. If warranted, the investigation is referred to the appropriate Federal or State law enforcement agencies for prosecution of the individual(s) involved. These agencies include the Federal Bureau of Investigation, the Defense Criminal Investigative Service, State Insurance Fraud Division(s), and the United States Attorney's Office. This team approach has been effective in deterring the rippling effect of insurance fraud.

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How can you help detect dental fraud?

Subscribers, sponsors, family members and dentists are in a good position to detect and report possible fraud. The dentist's review of the claim form, prior to submission, and the subscriber's, sponsor's or family member's review of the dental explanation of benefits (DEOB) form, issued by United Concordia, help ensure information is accurate and truthful. Facts to confirm:

• The type and number of services provided.
  
  
• The date(s) of service.
  
  
• The services reported were rendered.
  
  
• The patient's cost share or copayment amount owed was collected.