There are several ways of preventing
opportunities for a provider to commit fraud. The
following procedures also can protect you from
becoming a victim.
- Never sign a blank insurance
- Keep detailed records of the
treatment you receive and the amounts that
- Ask your providers what prices
- Know what your benefits are.
- Review your Explanation of Benefits
- Question your health provider
and ask for clarification if you see problems
or inconsistencies on your bills.
- Demand detailed bills for services
and check them closely for accuracy.
sure "free services" aren't
charged to your insurance carrier.
- Keep your insurance identification
- Be aware that if someone says
they can bill your insurance program so that
an uncovered treatment is paid for, you are
being pulled into an illegal scheme. You could
lose your insurance coverage, lose your job,
be arrested, or be fined or jailed.
- Contact the authorities if you
think you have knowledge of, or have been
involved in or a victim of fraud.
- Check your
Explanation of Benefits statement for accuracy.
- Question any
charges or services that appear to be incorrect.
- Report any
suspicion of fraud.
- Keep your
insurance information secure.
- Know what
your benefits and responsibilities are.
- Get a
receipt for any payments you make.
Do not ask
your dentist to:
- Submit a
date of service that is not accurate.
- Submit for a
dental service or procedure that was not
- Omit other
insurance carrier coverage and payments from
your claim form.
information regarding any discounts extended to
you, or any intention to waive your copayment
- Change the
amount of the fee charged for any of the
services billed for on your claim form.
If you are
submitting your own claim form, do not:
- Alter any
fees or dates of service.
- Change any
- Add any
procedure codes that were not performed.
Do not loan your
insurance information to any other individual.
Remember, anyone who knowingly benefits from an act
of insurance fraud is equally guilty of the offense
of health care fraud.
submitting a claim form that reflects any of the
above may result in the violation of:
- The Delta
Dental of New Jersey Participation Agreement
- The New
Jersey State Board of Dentistry Administrative
- The New
Jersey Insurance Fraud Prevention Act
- The New
Jersey Health Care Claims Fraud Act
Connecticut, the General Statutes of Connecticut
- The Federal
Health Care Claims Fraud Act
Fraud hotline: 888-696-3262
Delta Dental of New Jersey, Inc.
Special Investigations Unit
1639 Route 10
Parsippany, NJ 07054