Our contact center will be closed for staff training from 1:00 p.m. (CT), Tuesday, May 31 through 5:00 p.m. (CT) Wednesday, June 1. We look forward to serving you again beginning at 8:00 a.m. (CT) on Thursday, June 2, 2022. Thank you for your patience as we work to provide you even better service in the future.

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;

Help prevent fraud, waste, and abuse 

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.

Fraud, waste, and abuse report form

Use our online form to report suspected fraud, waste, or abuse. Please describe the situation in detail so we can fully investigate your report.

Fraud report form

Contact us

about fraud, waste, or abuse

Compliance Manager

Compliance resources 

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