How to Report Dental Insurance Fraud

Dental insurance fraud occurs when someone steals valid coverage to either obtain services or receive compensation from an insurance company. An individual can commit fraud independently (e.g., by letting a friend use your dental insurance) or participate in an organized scheme (e.g., charging insurance company more than should be billed). In all states, intentional insurance fraud represents a criminal violation. Federal criminal violations can arise depending on the extent of the fraud.

Gather relevant information to support your suspicions. You could disclose the name and addresses of the scam artists. When dealing with a dentist who overcharges for services or do not report patient co-payments, you could provide direct contact information, such as the dentist’s office location and phone number.

Contact the fraud department of your state’s fraud or insurance department (e.g., insurancefraud.org/fraud_bureaus.htm). For example, if you are a consumer in Delaware, contact the Department of Insurance and file a complaint by email at consumer@state.de.us or by telephone 1-800-282-8611.

Notify the insurance company directly. If the dental insurance is through Blue Cross Blue Shield, call the anti-fraud hot line at 1-800-482-378. Medicaid maintains an Office of Medicaid Inspector General in each state to gather information about fraudulent activity. You can make anonymous report of Medicaid fraud in New York at (877) 873-7283.

File a complaint with the Better Business Bureau (bbb.org/us/consumers) that describes the fraud. The BBB collects and publishes information about businesses and nonprofits throughout the United States. In 2008, the BBB received over 272,000 inquiries about dentists.