Dental Insurance Fraud Is An Ongoing IssueUnfortunately, it's fairly easy to become a victim of dental insurance fraud. In fact, most people who are victims never have any idea, even long after the fraud has been committed. The reason is simple. When a person goes to see their dentist they trust that their dental health plan will be charged the correct amount for the procedures that are completed. However, many dental offices knowingly overcharge dental insurance companies so they can reap the rewards.
When a person first visits a new dental office they are almost always required to provide details about their dental health plan. This information usually includes the monetary limit of their yearly coverage as well as how much of a percentage they are responsible for. In almost every case of dental insurance fraud, the victims are those individuals who have 100% coverage on the basics. The idea behind this type of insurance fraud is relatively simple. The insured visits the dentist for a minor procedure. This may be a yearly examination with a cleaning or perhaps a standard filling. The dental office may bill for these minor procedures but in this scam they will add many extras onto the total bill that is submitted to the dental health plan. Another way that dental offices perpetrate insurance fraud is by miscoding the procedures. Most dental claims are submitted electronically now which means the patient never sees or signs a claim form authorizing the expense. Instead the person responsible for submitting the claims at the dental office uses a system of standard codes to identify which tooth was worked on as well as what was done to it. By miscoding one or the other of these numbers, the insurance company receives a bill that is exaggerated. Yet another way that dental offices conduct insurance fraud involves billing procedures that are performed on one patient to another patient. This usually involves one patient who has their information stored with the dental office but hasn't visited in some time. The dental office then uses that person's information to submit a claim for work done on another. The dental healthcare plans that are involved typically approve and pay for the claims because the person's whose name was used in the claim hasn't yet used up their total for the year. Again, this is very hard to detect unless the patient receives a notice explaining their recent treatment expenses. One big problem that law enforcement personnel face with dental insurance fraud is that the dental offices can always claim that they simply made a human error in the processing. This could hold weight in the case of the procedure being miscoded as well as charging the wrong patient. |