What should I do if I suspect dental fraud?

According to the National Health Care Anti-Fraud Association, of the $250 billion spent on
dental care procedures annually, an estimated $12.5 billion—or 5%—is lost to dental fraud and
abuse. Prevention and detection of fraud and abuse is in everyone’s best interest. Preventing
fraudulent activities can help lower costs and increase overall satisfaction for providers,
members, and employers.

Fraudulent claims lead to insurers paying claims they don't owe which has an impact on
insurance premiums. Beam strives to protect our customers by thoroughly investigating claims
of insurance fraud and referring those who commit fraud to the appropriate law enforcement
agencies.

Signs of fraud:

  • Billing for services not rendered—either by using genuine patient information,
    sometimes obtained through identity theft, to fabricate entire claims or by padding
    claims with charges for procedures or services that did not take place
  • Billing for more expensive services or procedures than were provided or performed,
    commonly known as “upcoding” i.e. falsely billing for a higher-priced treatment than
    what was rendered. For example, a dentist may perform a dental prophylaxis (routine
    cleaning) but file the claim for 4 quadrants of scaling and root planning.
  • Misrepresenting non-covered treatments as medically necessary covered treatments for
    purposes of obtaining insurance payment.
  • Performing medically unnecessary services solely for the purpose of generating
    insurance payments.
  • Waiving of member deductible and/or co-payment (viewed as overbilling the insurance
    company).
  • Alterations on the bill or claim form, e.g. erasures, strikeovers, whiteout, or correction tape.

How can you report fraud?

Complete the Fraud Complaint form below and submit to fraud@beam.dental or call (800) 648-1179.

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