In 2009, the National Health Care Anti-Fraud Association (NHCAA) estimated that 3-10% of the nation's annual benefits paid for health care were paid for fraudulent or abusive submissions. Estimations by fraud analysts indicate that there is a greater percentage of fraud in dentistry than there is in medicine. Because insurance fraud significantly impacts the cost of dental benefits, you can play a key role in identifying and reporting suspicious activity.
The NHCAA reports that the most common fraudulent acts include:
- Billing for services or supplies that were never provided or performed.
- Intentionally misrepresenting any of the following, for purposes of obtaining a payment - or a greater payment - to which one is entitled:
- The nature of services supplies provided or performed;
- The dates on which services were rendered;
- The medical record of services provided;
- The diagnosis or condition treated;
- The charges for services provided or performed; and,
- The identity of the provider or of the recipient of services.
- The deliberate performance of unnecessary services for the purpose of financial gain.
The close monitoring of processed claims via Superior Dental Care's (SDC's) secure web access
(Superior Direct Connect: www.superiordental.com/directConnect.htm) is one easy way to monitor submitted and received claims. If you are aware of any false information
submitted to SDC, please contact our Dentist and Member Services Team at 937.438.0283 or 800.762.3159 to report the activity. If preferred,
a written complaint may be mailed to: Superior Dental Care Alliance Inc., Special Investigating Unit, 6683 Centerville Business Parkway,
Centerville, OH 45459.
SDC's Special Investigating Unit handles all reports of suspected fraud expeditiously and
with confidentiality. Reports are accepted anonymously; but, every report initiates an investigation.
SDC takes necessary actions to report confirmed fraudulent activities to appropriate state agencies and to recover monies paid
in association with misrepresented services.