Insurance fraud occurs when someone knowingly lies to receive some sort of benefit or monetary gain that they are not entitled to otherwise, according to the California Department of Insurance. Dental insurance fraud may happen when a dental office inflates bills or falsifies billing codes. Using the dental insurance card or benefits of another person by claiming to be that person is also dental fraud. Insurance fraud increases the cost of health care. If you are aware of any type of fraud, make sure to report it.
Step 1
Record and gather as much information as you can about the suspected fraud: dates, names of those involved, organization phone and addresses involved in the fraud, contact information of insurance companies that were defrauded, amount of money you believe was lost, and any additional information helpful in supporting your report.
Step 2
Report the fraud to the insurance company that you believe was defrauded. Dental insurance companies have fraud departments and will take your report over the phone or in writing. Be sure to have any supporting documentation available to provide to the insurance company.
Step 3
Contact the fraud bureau for your state. According to Insurancefraud.org, most states have fraud bureaus that are state agencies that detect, investigate, and prevent insurance scams. You can report insurance fraud via the phone or through the state agency's website.
Step 4
Call (800) 447-8477, the Inspector General's fraud hotline, if you think the dental fraud involves the defrauding the Federal government's Medicaid or Medicare programs.
Step 5
Report the dentist or medical provider to your state's medical board if you believe she is involved in defrauding dental insurance companies or members.
Step 6
File a police report with your local police department if you are a victim and lost money to due dental fraud or someone used your dental benefits (identity theft). Be sure to provide any supporting documentation proving that you were a victim of fraud.
Tips and Warnings
- Report fraud as soon as possible, avoiding delays in the investigation. Keep track of the dates and organizations you report he fraud to for future reference.
Things You'll Need
- Names and contact information of persons or organizations involved in the fraud.
- Documentation or proof supporting the fraud allegations.
