You’re probably familiar with identity theft, tax scams, credit card fraud, and mail fraud. But have you ever heard of dental fraud?
It’s happening more than you think. How do you protect yourself from dental fraud? Dr. Joseph Harmon with Delmarva Dental Services in Salisbury helps us answer that question.
Dr. Harmon says this type of fraud is concerning to him because most victims are unaware and remain unaware.
Dental fraud is lying and getting paid for dental services that did not actually happen. Dr. Harmon says like any business, there are honest and not so honest people, and unfortunately, this is true of dentistry as well.
Types of dental fraud include:
- Unnecessary treatment, such as root canal or crown
- Billing for treatment not performed, such as x-rays that were not taken
- Upcoding, which is the most common. Upcoding is making a procedure more complicated than it was. For example, routine vs. surgical extraction, bigger filling than actually was, routine cleaning as gum treatment
- Unbundling, which is breaking down the procedure into parts so it cost more
Typical targets include:
- Members of government insurance programs like Medicaid
- Certain groups
- Children
- Members of Insurance Companies with limited number of participating
Dr. Harmon says we should ask plenty of questions about the procedure and get an estimate before treatment begins and have the procedure explained fully. Dr. Harmon says taking these precautionary measures will help protect the patient.
Dr. Harmon also says it’s important to ask about seeing x-rays and photos after they are completed and ask for copies of findings. Dr. Harmon says it’s also important to watch the body language and attitude of the dentist and do not hesitate to get a second opinion.
Lastly, Dr. Harmon tells us about a thing called dental neglect, which is the ignoring, overlooking, not informing, undertreating or not treating a condition. However, Dr. Harmon says dental neglect is separate from dental fraud. Maybe we can have Dr. Harmon back on the show soon to discuss that topic.
