Special Investigations Unit Looks Into Hundreds of Cases of Suspected Fraud Each Year

Delta Dental is committed to stopping fraud. Our Claim Verification department, also known as the Special Investigations Unit (SIU), has operated since 1981. It works to prevent, detect and pursue fraud, abuse and overbilling.

We are required by the New Jersey Insurance Fraud Prevention Act (IFPA) to implement state-approved fraud detection plans and maintain a full-time unit to investigate possible fraud. Our SIU investigates claims referred by claims personnel and applications referred by underwriting personnel. It also reviews information received from patients, dentists, dental office staff, employer groups, and government agencies about possible cases of fraud.

Our SIU receives more than 200 referrals each year. We investigate each referral. If there is a reasonable suspicion of fraud, we notify the appropriate law enforcement agencies as required by law. We are required to report any reasonable suspicion of fraud to the Office of the Insurance Fraud Prosecutor (OIFP). Failing to do so could result in penalties of up to $25,000 per violation.

For more information, please refer to:

• New Jersey State Board of Dentistry, Administrative Code [NJAC 13:30-8.10].

• The New Jersey Health Care Fraud Claims Act [N.J.S.A. 2C: 21 4.2-3].

• The New Jersey Insurance Fraud Prevention Act, [N.J.S.A. 17:33A 1-4].

• The General Statutes of Connecticut [Volume 7, Title 20, Chapter 379 Sec. 20-114].

• The Delta Dental of New Jersey Participation Agreement.

• The Delta Dental of New Jersey Dentist Handbook for Participating Dentists, Chapter 2, Rules and Regulations and Chapter 11, Claim Verifications.

To report any suspected fraud to Delta Dental of New Jersey:

• Call our fraud hotline: (888) 696-3262

• E-mail: reportfraud@deltadentalnj.com

• Fax: (973) 944-4573

• Write to: Delta Dental of New Jersey
  Special Investigations Unit
  1639 Route 10
  Parsippany, New Jersey 07054