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
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-3B
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.
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