Fraud and Abuse

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:

• Use the Online Fraud Complaint Form submission form, which can also be found in the Forms/Materials section.
• To submit written correspondence, download the pdf file for printing and send to:
  
        United Concordia Companies, Inc.
        Special Investigations Unit
        4401 Deer Path Road, DP-4F
        Harrisburg, PA 17110
        Fax: 717-260-7204
• Contact the toll-free "Fraud Hotline" at 1-877-968-7455.

The SIU maintains a 24-hour confidential voice mailbox for reporting suspected fraud.

United Concordia Fraud Success Stories