Help Us Fight Fraud and Abuse

Delta Dental of Arizona is committed to fighting dental insurance fraud because it negatively impacts our policyholders. 

The United States spends more than $3.6 trillion on health care annually. An estmated 3-10% of that—or up to $300 billion—is lost to fraud each year.1 Whether you have employer-sponsored benefits or buy an individual insurance policy, health care fraud can increase the cost of your benefits, treatments and even affect your coverage options. While it’s only a small percentage of providers or consumers who commit health care fraud, that small percentage can have a big impact.

What Is Fraud and Abuse?

It's important to understand fraud, waste and abuse so you can recognize and report any misconduct:

  • Fraud is an intentional deception or misrepresentation of fact that can result in unauthorized benefit or payment. Fraud can violate civil and criminal law.
  • Waste is the overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the health care systems. 
  • Abuse is defined as provider actions that are inconsistent with sound fiscal, business or medical practices. Unlike fraud, abuse is an unintentional practice that directly or indirectly results in an overpayment to the provider. 

Examples of Fraud, Waste and Abuse

Some examples of provider health care fraud are:

  • Billing for services not rendered
  • Billing for a more costly service than the one actually performed
  • Altering a service or treatment on a claim to obtain higher payment
  • Altering a date of service to fall within a patient's eligibility

Some examples of consumer health care fraud are:

  • Using someone else's ID card to get care
  • Hiding additional insurance coverage
  • Forging or altering bills or receipts

Ways to Prevent Fraud and Abuse

Anyone can recognize signs of possible fraud and take steps to avoid fraudulent business practices.

As a Patient:

  • Protect your Delta Dental benefits card like you would your credit card. Don't let anyone borrow your card or use your ID number. If your card is lost or stolen, contact us.
  • Always review your Explanation of Benefits (EOB). Ensure that the date, service and dentist information are accurate. If something doesn't seem right, contact the dental office for an explanation. 
  • If you suspect fraud, report it right away.

As a Dental Office:

  • Always disclose any discounts, coupons or waivers of copay.
  • File claims with the utmost accuracy. Never alter a date or file a misleading treatment to maximize a patient's benefits.
  • Review claim forms before submission and make sure the treatment in the patient's clinical notes is accurately reflected on the claim form.
  • Make sure the dentist listed on the claim form as the treating dentist is the one who performed the patient's services.

Suspect Fraud? Report It!

If you suspect someone of committing fraud or abuse, please help us keep costs down. Contact us immediately. You may remain anonymous or share your contact information and request that your name not be used.

  • Call our toll-free compliance hotline: 855.372.8345
  • Report fraud online: Go to www.fraudhl.com and enter company code DDAZ on the fraud report form.
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1National Health Care Anti-Fraud Association, 2018

2Delta Dental of Arizona internal data, 2017-2019