Protect yourself from fraud

The signs of fraud

Health care fraud can directly affect your benefits by increasing the cost of your dental plan and jeopardizing your employer's ability to offer those benefits.

It's only a small percentage of providers or consumers who commit healthcare fraud, but that small percentage can have a big impact. Consider this: The U.S. spends more than $2 trillion on healthcare annually. At least 3 percent of that spending — or $68 billion — is lost to fraud each year.1

Delta Dental takes a strong position to prevent fraud from affecting your benefits.

Sometimes fraud comes in predictable forms, and other times it is less obvious, but fraud always leaves traces. Here are some examples of fraudulent practices:

  • Dental offices that routinely fail to charge or collect your full coinsurance or copayment amount or deductible. This amounts to overbilling the insurance company for the services rendered.
  • Dentists that perform unnecessary treatment (e.g. x-rays, fillings and crowns that aren’t needed)
  • Patients or dental offices that conceal other insurance coverage
  • Incorrect information on your notice of payment (NOP - also called "Your dental benefits statement" or an explanation of benefits)
  • Individuals who use someone else's identification number
  • Patients who persuade the dental office to falsify the date of treatment
  • Dental offices that submit a claim for a covered service, when actually a non-covered service was performed
  • DeltaCare® USA dental facilities that limit the availability of appointment times or follow-up visits.

If you are covered by a Delta Dental Premier® or Delta Dental PPOSM plan, after you receive treatment, you will receive a notice of payment (NOP) from Delta Dental, which lists the services that were provided, the dates of services and the amount your dentist is charging. Please review the notice for accuracy. Incorrect information on an NOP can be a sign of fraud and should be reported to Delta Dental.

  • 1National Health Care Anti-Fraud Association, 2008

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