Stopping Insurance Fraud

United Concordia’s efforts to protect our customers and what you can do to help

Insurance fraud affects everybody. When fraudulent dental claims come in, more money is paid on those claims, and this eventually affects insurance premiums. We strive to protect our customers by thoroughly investigating claims of insurance fraud and referring those who commit fraud to the appropriate law-enforcement agencies.

 

What’s the actual cost of insurance fraud?

The United States General Accounting Office reports that health care fraud adds at least 10 percent annually to the nation's health care costs. In an effort to curb fraud, we monitor all claim submissions received and rely on various tools to uncover questionable reporting, over-utilization and potential fraud schemes.

 

So what happens if fraud is suspected?

Once United Concordia identifies an alleged fraud scheme, we collect reliable evidence to determine investigative merit. If warranted, the investigation is referred to the appropriate Federal or State law enforcement agencies for prosecution of the individual(s) involved. These agencies include the Federal Bureau of Investigation, the Defense Criminal Investigative Service, State Insurance Fraud Division(s) and the United States Attorney's Office. This team approach has been effective in deterring the rippling effect of insurance fraud.

 

How can you help stop insurance fraud?

Members, sponsors, family members and dentists are in a good position to detect and report possible fraud. The dentist's review of the claim form, prior to submission, and the member's, sponsor's or family member's review of the dental explanation of benefits (DEOB) form, issued by United Concordia, help ensure information is accurate and truthful. Facts to confirm:

  • The type and number of services provided
  • The date(s) of service
  • The services reported were received
  • The patient's cost share or copayment amount owed was collected 

 

How do you report fraud?

United Concordia treats all reports of suspected fraud confidentially. 

 

Online

Click here for the Online Fraud Complaint Form

 

Telephone (toll-free)

United Concordia maintains a 24-hour, confidential voicemail box for reports of suspected fraud: 1-877-968-7455

 

Mail

If you prefer mail, download the Fraud Complaint Form PDF icon to printing and complete, then send to:

United Concordia Companies, Inc.
Special Investigations Unit
4401 Deer Path Road, DP-4F
Harrisburg, PA 17110
Fax: 717-260-7204