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Help us in our fight against fraud
We are committed to our members, providers and customers to be vigilant against
suspected fraud. Although we believe that only a small percentage of people engage in
fraudulent activities, the damage they do far exceeds their numbers. If ignored, fraud
inflates the cost of healthcare and can undermine access to affordable healthcare coverage.
What is fraud?
Fraud is a crime of intentional deception or misrepresentation in which an individual or
entity deceives an insurance company, usually to gain reimbursement or insurance benefits.
Fraud can take place in many ways and may be committed by any party to healthcare delivery.
You can make a difference.
You can help us in our fight against fraud by being able to recognize signs of fraud and
knowing how to report your suspicions. Provider’s can review claim forms prior to submission
and subscribers/members can review the Explanation of Benefits (EOB’s) (sent to members only
if there is a patient co-payment responsibility) to ensure information is accurate and truthful.
Information to review:
- Name and address of the providers office
- Date(s) of service
- Type and number of the procedure(s) provided
- Fees charged and the amount of co-payment that was collected
Fraud leaves traces and recognizing those traces requires the efforts of all of us.
Examples of fraudulent practices:
- Billing for services not provided
- Changing the date of service to gain payment
- Inaccurate billing of services
- Waiving patients co-payment and/or deductible
- Billing for a covered service when a non covered service was performed
- Individuals who use someone else’s identification card
- Subscriber/members or provider offices that conceal other insurance coverage
To report suspected fraud, please use one of the following options:
1. Call our Fraud Hotline at: 877-833-3682
2. Complete the
Fraud & Abuse Form and mail it to:
Utilization Management
DentaQuest
465 Medford Street
Boston, MA 02129
3. Or print the Fraud & Abuse Form and fax it to: 617-886-1488
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