United Concordia takes a strong stand against fraudulent
and abusive practices. Fraud and abuse can take
many forms, including:
Submitting claims for services
not rendered
Submitting claims for non-covered
services disguised as covered benefit services
Identity thefts submitting claims
for a non-eligible individual as a covered beneficiary
Duplicate claim submissions
Misrepresentation by the dentist of
his or her credentials
Concealment of information (by
the dentist) regarding business practices which
disqualify him or her as an authorized TDP provider
Improper billing practices,
including submitting claims for unnecessary dental services
Routine waiver of member cost-share
You have the ability and opportunity to detect any fraud
that may have occurred. The key is careful review
of your Dental Explanation of Benefits (DEOB). Make
sure that the information on the DEOB matches the
services you received, by verifying the:
Date of service
Type of services rendered
Payment issued was for the actual
services rendered
Reporting Fraud and Abuse
If you believe a dentist or entity has received
insurance money through the submission of a false
claim, you should report this information to
the Special Investigations Unit (SIU).
United Concordia provides several ways for enrollees
to contact the SIU:
