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Fraud and Abuse

What is fraud and abuse?

Fraud is the intentional deception or misrepresentation of facts, knowing that the deception could result in unauthorized benefit or payment.
 
Abuse is an action inconsistent with sound fiscal, business or medical practice that results in an unnecessary cost to Delta Dental or in reimbursement for medically unnecessary services. Abuse includes violations of an agreement or certificate of coverage or failure to meet professionally recognized standards of health care.

What can you do?

  • Treat your health benefits identification like a credit card.
  • Don't let anyone borrow your card. If it is lost or stolen, call customer service right away at 800-524-0149.
  • Protect yourself from identity theft.
  • Look carefully at each Explanation of Benefits (EOB) you receive.
    • After you've visited a dentist’s office, an EOB is issued informing you what has been billed. Make sure you had the visit or service on the date stated on the EOB. If it doesn't seem right, call the dentist or other health care provider and ask them to explain it to you. If you want some help reading an EOB, please call customer service.

Report fraud and abuse

If you suspect someone of fraud or abuse, please contact us immediately. You may remain anonymous.

  • Call our anti-fraud hotline at 800-524-0147.
  • Complete and submit the Fraud or Abuse Complaint Form. Please provide a detailed account of the incident or service(s).