Help prevent fraud, waste, and abuse
Compliance & cultural competency training
This presentation deck for dental offices explains best practices for fraud/waste/abuse, compliance, and cultural competency.
Fraud, waste, and abuse
Delta Dental of South Dakota committed to conducting business in an ethical manner and in compliance with all federal, state and local laws, regulations and standards. Part of our committment to compliance is the prevention and detection of fraud, waste, and abuse.
What are fraud, waste, and abuse?
Fraud is the intentional deception or misrepresentation by a person for profit or to gain an unfair advantage.
Waste is the over utilization, underutilization, or misuse of resources.
Abuse is conduct inconsistent with fair, ethical, dental, business or fiscal practices and which could result in unnecessary costs and/or payments.
Examples
- Using someone else's identification card to get care;
- Concealing other insurance coverage;
- Billing for services not rendered;
- Billing for a service that is covered when a non-covered service was performed to gain payment;
- Altering service or treatment in claims submission to obtain benefit payment for a different, more expensive, treatment; and
- Altering the date of service to fall within eligibility;
As a patient:
- Treat your Delta Dental insurance member card like a credit card. Don’t let anyone borrow your card or use your ID number. If your card is lost or stolen call Customer Service at 877-841-1478.
- Carefully review each Explanation of Benefits (EOB) you receive after a dental visit. Make sure the visit/service date are accurately stated on the EOB. If the date or services listed don't seem right, contact the dental office to ask for an explanation. If you want help reading the EOB, call Customer Service at 877-841-1478.
As a dental office:
- Review claim forms prior to submission, making sure the treatment in the patient’s clinical notes is accurately reflected on the claim.
- Make sure the dentist listed on the claim as the treating dentist is the one who actually performed the services.
- Disclose all discounts or waivers of any co-payment.
- Accurately file claims. Do not alter dates of services or file misleading treatment to maximize a patient’s benefits.
Suspect fraud, waste, or abuse? Report it!
Contact us immediately if you suspect fraud, waste, or abuse. You may remain anonymous or provide your contact information.
Contact us
about fraud, waste, or abuse
Compliance Manager
Compliance resources
DDSD fraud prevention and detection policy
DDSD policy statement and procedures to prevent fraud and how stakeholders can report suspected fraud, waste, or abuse.
DDSD compliance program policy
Policy statement and overview of how DDSD fulfills seven program elements for effective compliance in business operations.
