Help us fight fraud

We are committed to our members, providers, and customers to be vigilant against suspected fraud. Although we believe that only a small percentage of people engage in fraudulent activities, the damage they do far exceeds their numbers. If ignored, fraud inflates the cost of healthcare and can undermine access to affordable healthcare coverage.

What is fraud?

Fraud is a crime of intentional deception or misrepresentation in which an individual or entity deceives an insurance company, usually to gain reimbursement or insurance benefits. Fraud can take place in many ways and may be committed by any party to healthcare delivery.

You can make a difference.

You can help us in our fight against fraud by being able to recognize signs of fraud and knowing how to report your suspicions. Providers can review claim forms prior to submission and subscribers/members can review the Explanation of Benefits (EOBs) (sent to members only if there is a patient co-payment responsibility) to ensure information is accurate and truthful.

Information to review:

Name and address of the provider's office
Date(s) of service
Type and number of the procedure(s) provided
Fees charged and the amount of co-payment that was collected
Fraud leaves traces and recognizing those traces requires the efforts of all of us.

Examples of fraudulent practices:

Billing for services not provided
Changing the date(s) of service to gain payment
Inaccurate billing of services
Waiving patient's co-payment and/or deductible
Billing for a covered service when a non-covered service was performed
Individuals who use someone else’s identification card
Subscriber/members or provider offices that conceal other insurance coverage

To report suspected fraud, please use one of the following options:

 
For Medicare Advantage/Medicaid
For Group Plans
Fraud Hotline:
 
800-237-9139
 
877-833-3682
 

Anonymous Hotline:
 

866-654-3433
 

866-654-3433
 

Fraud and Abuse Forms
 
Medicare Advantage/Medicaid Form
 
Group / Individual Form
 
Mail it to:
 
DentaQuest
12121 North Corporate Parkway
Mequon, WI 53092
 
DentaQuest
465 Medford Street
Boston, MA 02129
 
Or print the Fraud & Abuse Form
and fax it to:
262-241-7366 617-886-1488