Stopping Insurance Fraud
United Concordia’s efforts to protect our customers and how you can help
Insurance fraud affects everybody. When fraudulent dental claims come in, more money is paid on those claims and this eventually affects insurance premiums. We strive to protect our customers by thoroughly investigating claims of insurance fraud and referring those who commit fraud to the appropriate law-enforcement agencies.
The actual cost of insurance fraud
The United States General Accounting Office reports that health care fraud adds at least 10 percent annually to the nation's health care costs. In an effort to curb fraud, we monitor all claim submissions received and rely on various tools to uncover questionable reporting, over-utilization and potential fraud schemes.
What happens if fraud is suspected?
Once United Concordia identifies an alleged fraud scheme, we collect reliable evidence to determine investigative merit. If warranted, the investigation is referred to the appropriate Federal or State law enforcement agencies for prosecution of the individual(s) involved. These agencies include the Federal Bureau of Investigation, the Defense Criminal Investigative Service, State Insurance Fraud Division(s) and the United States Attorney's Office. This team approach has been effective in deterring the rippling effect of insurance fraud.
How you can help stop insurance fraud
Members, sponsors, family members and dentists are in a good position to detect and report possible fraud. The dentist’s review of the claim form, prior to submission, and the member’s, sponsor’s or family member’s review of the dental explanation of benefits (DEOB) form, issued by United Concordia, help ensure information is accurate and truthful. Facts to confirm:
- The type and number of services provided
- The date(s) of service
- The services reported were received
- The patient's cost share or copayment amount owed was collected
