Report Fraud

 

We are committed to our members, providers, and customers to be vigilant against suspected fraud. Although we believe that only a small percentage of people engage in fraudulent activities, the damage they do far exceeds their numbers. If ignored, fraud inflates the cost of healthcare and can undermine access to affordable healthcare coverage.

 

Fraud is a crime of intentional deception or misrepresentation in which an individual or entity deceives an insurance company, usually to gain reimbursement or insurance benefits. Fraud can take place in many ways and may be committed by any party to healthcare delivery.

 

You can help us in our fight against fraud by being able to recognize signs of fraud and knowing how to report your suspicions. Providers can review claim forms prior to submission and subscribers/members can review the Explanation of Benefits (EOB, sent to members only if there is a patient responsibility) to ensure information is accurate and truthful.

 

• Name and address of the providers office
• Type and number of the procedure(s) provided
• Fees charged and the amount of co-payment that was collected

 

• Billing for services not provided
• Changing the date of service to gain payment
• Inaccurate billing of services
• Waiving patients co-payment and/or deductible
• Billing for a covered service when a non-covered service was performed
• Individuals who use someone else’s identification card
• Subscriber/members or provider offices that conceal other insurance coverage

 

1. Call our Fraud Hotline at 866-767-1675
2. Complete the Fraud Form and mail it to:

Utilization Management
Delta Dental of Massachusetts
P.O. Box 9695
Boston, MA 02129

3. Or print the Fraud Form and fax it to 617-886-1488