Where Do I Report a Dentist for Fraud?

If you suspect dental fraud, you have an obligation to report it.

According to the National Health Care Anti-Fraud Association, federal and state governments and private insurance companies lose $189 million dollars a day because of health care fraud. In order to recoup this cost, companies charge higher health care premiums, and governments raise taxes. If you suspect that your dentist is committing fraud, you have a responsibility to report it. (see reference #1, page 7)

Reporting

You can report dental fraud directly to your insurance company. If your insurance is paid for by the state, you should go to your state's official website and contact the Department of Human Services. Your state's attorney general may also be able to help you.

Info Needed

When reporting a dentist, provide his name, address and phone number, the name and address of the hospital or place where you were treated, the dentist's Medicaid number (if you know it), the date the fraud happened, names and phone numbers of any witnesses, and a description of what happened.

Examples

Examples of fraud include billing for services that weren't provided, misrepresenting services that were provided, and billing for covered services but performing cosmetic services. Other examples are double billing, altering records, submitting a claim under one person's name when the work was done for someone else, performing unnecessary tests, and routinely waiving a patient's co-pay.

References

• National Health Care and Fraud Association: Health Care Fraud and Dentistry
• Office of the Maine Attorney General: Welfare Fraud
• Community Health Choice: Reporting Waste, Abuse or Fraud

Resources

• Federation of State Medical Boards: Doc Info
• Federation of State Medical Boards: Directory
• National Health Care and Fraud Association: Health Care Fraud and Dentistry
• American Association of Dental Boards: State Dental Boards