Compliance & Fighting Fraud
Corporate Compliance: What Is It?
Simply put, corporate compliance means:
- We know what laws impact us.
- We comply with those laws.
- We always act ethically.
We have a corporate compliance program to ensure our employees, participating dentists, subscribers, and business partners are aware of the laws and standards with which we are required to comply. We are committed to preventing, detecting, and deterring fraud. Components of our internal corporate compliance program:
- Corporate Compliance Committee
- Corporate Integrity Hotline
- Compliance Training
- HIPAA (Health Insurance Portability and Accountability Act) Compliance
- Code of Conduct for Team Members
Help Us Fight Fraud & Abuse
The purpose of Delta Dental of Colorado’s Program Integrity department is to prevent, detect, and deter fraud and abuse.
Is it Fraud or Abuse?
Fraud is an intentional deception or misrepresentation of a fact that an individual or entity makes, knowing that the misrepresentation could result in an unauthorized benefit to the individual, entity or some other party. Abuse is an intentional pattern of conduct that is inconsistent with sound, ethical, dental, business or fiscal practices and which could directly or indirectly result in unnecessary costs and/or payments.
Cost of Fraud
The United States spends almost $4 trillion each year on health care. The National Healthcare Anti-Fraud Association estimates that between 3 and 10 percent of those expenditures result from fraud or abuse. Delta Dental takes fraud seriously because it negatively impacts our subscribers. While it’s only a small percentage of providers or consumers who commit health care fraud, that small percentage can have a big impact.
You Can Help
Help us fight fraud and abuse by recognizing signs of possible fraud and knowing how to report your suspicions. Providers can review claim forms prior to submission. Subscribers should review the Explanation of Benefits forms they receive from Delta Dental.
Examples of fraudulent practices:
- Billing for services not rendered
- Billing for a service that is covered, when a non-covered service was performed, in order to gain payment
- Altering service or treatment in claims submission to obtain benefit payment for a different, more expensive, treatment
- Altering the date of service to fall within member’s eligibility
- Concealing other insurance coverage
- Individuals who use someone else’s identification card
Suspect Fraud? Report It!
Complete the online Fraud and Abuse Report Form.