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It’s important to understand a few things about dental billing as a dental patient. Fraudulent billing practices can cost you money and jeopardize your dentist’s practice. Knowing what to look for will help you avoid being taken advantage of.
In this article, we’ll discuss how dental bills work, ways they could potentially be fraudulent, and how to protect yourself from dental billing fraud.
When dentists bill for services, they’re expected to be honest about what services were performed and what they charged. But dentists can make fraudulent claims, especially when insurance companies or federal healthcare programs enter the picture.
If you have dental insurance, it may cover all or part of a given treatment. Your dentist can get more money from your insurance provider by claiming the completion of additional services or inflating costs.
These fraudulent claims are illegal and can cost you and your insurance company. If insurance will not fully cover the cost of a certain treatment, your dentist may pass on the rest of that extra cost to you.
It’s not always easy to spot fraudulent dental billing, but there are some possible tells, including:
Keep in mind that fraud requires intent. It’s possible for dental office staff to unknowingly file bills illegally due to human error.
For example, your records could be confused with someone else’s. Alternatively, the dental office may neglect to update information when you switch to a new insurance provider or when they get new dental billing software. This would be considered negligence rather than fraud.
However, dental billing mistakes like these can cost you money and put your dental office in legal trouble. Intentional or not, you should question any discrepancies in your bill.
Common illegal dental billing practices include:
Dental insurance fraud can have monetary and legal repercussions, putting patients, dentists, and dental practice staff at risk.
With fraudulent dental practices, losing money is the most obvious and immediate risk for you as a patient. If your dental office inflates their bills and your insurance coverage isn’t 100%, the remainder of the cost will likely be passed on to you.
This is especially risky if you pay out of pocket upfront and expect to be reimbursed afterward by your insurance. A fraudulent dental office might submit an additional claim without telling you.
Another risk to the patient is having to undergo unnecessary procedures. A dentist may recommend expensive and invasive treatments in cases that require no more than minor preventive care.
This means that, besides spending more money, you could needlessly undergo invasive treatment. You may also require follow-up procedures later, adding to the cost.
Legal consequences for dentists or staff found guilty of fraud can vary. In most cases, the dentists will at least have to pay penalties or fines. Additional consequences can include suspension of their license, probation, and even prison time.
In some cases, dental office staff are found to have committed fraud without the knowledge of the practicing dentist. If this happens, the dentist might be found not guilty or guilty of negligence.
Being proactive and aware can help protect you from fraud. This includes paying attention to what you’re quoted and contacting your insurance provider.
To verify your dental bills, you should look closely at two documents: one from your dentist and one from your insurance company.
The one from your dentist is a written statement detailing your treatment and estimated costs. Most dentists provide this upfront before treatment begins. If your dentist doesn’t give you a statement, it’s wise to ask for one.
On the insurance side, you should review your explanation of benefits (EOB). This is a document provided by your insurance carrier (online or by mail) once they’ve processed the claim.
By comparing your EOB and your dentist’s estimate, you can check to ensure everything looks accurate.
Do the following if you notice signs of potential fraud from your dental office:
To prevent dental billing mistakes or fraud, do the following:
Dental billing fraud can cost you money and time and result in the completion of unnecessary dental work. To protect yourself, be on the lookout for any unusual items or discrepancies in your dentist’s cost estimate. It also helps to know your insurance policy well.
Contacting your insurance carrier is a good first step if you suspect fraud. You can also contact your state’s insurance watchdog agency for more resources.
