New Web Feature Gives You Tools to Help Fight Fraud

Health insurance fraud accounts for at least 10% of the annual expenditure on health care in the United States. It costs Americans an estimated $80 billion a year. Delta Dental is committed to combating dental insurance fraud. We recently launched the “Fight Fraud” section of our Web site to educate members, dentists, clients, and brokers about this costly problem, and provide resources to help eliminate it.

What to Look For

Can you recognize the signs of fraud? Our Web site includes a comprehensive list of fraudulent insurance practices. Some of these include:

• Submitting claims for services that were never performed.

• Misrepresenting the actual treatment rendered in an attempt to gain benefits.

• Misrepresenting treatment dates in an attempt to gain benefits.

• Billing insurance companies more for a service than what is charged on the patient ledger.

• Misrepresenting the diagnosis to justify payment for certain services.

• Misrepresenting the identities of patients, members or dentists.

• Not charging or collecting full co-payment, deductibles, or extended discounts and failing to disclose it on the claim.

How You Can Help Prevent Health Insurance Fraud

Patients play an important role in foiling potential fraud. Here’s how:

• Know your benefits. (You can check your benefits online using Benefits Connection. Go to www.deltadentalnj.com. Scroll over “Members,” click “Benefits Connection,” and log on.)

• Ask your dentist about his or her fees upfront.

• Never sign a blank claim form.

• Demand detailed bills for services and check them for accuracy. Ask for clarification if you see problems or inconsistencies on your bills.

• Review your Explanation of Benefits statements. Make sure “free services” aren’t charged to your insurance carrier.

Be aware that if someone says they can bill your insurance company so that an uncovered treatment is paid for, you are being pulled into an illegal scheme. You could lose your insurance coverage and even your job. You risk being arrested, fined, and jailed.

Reporting Fraud

You can report suspected fraud to us in several ways:

• Call our fraud hotline at (888) 696-3262

• E-mail us at reportfraud@deltadentalnj.com

• Fax us at (973) 944-4573

• Write to us at:

  Delta Dental of New Jersey
  Special Investigations Unit
  1639 Route 10 Parsippany, NJ 07054

For more about our efforts to eradicate fraud and how you can help, visit our Web site at www.deltadentalnj.com and click “Fight Fraud” on the left navigation bar.