Report Fraud | DentaQuest

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Plans","loginUrl":"https://govservices.dentaquest.com/"}]},{"state":"Wisconsin","plantypes":[{"planName":"All Plans","loginUrl":"https://govservices.dentaquest.com/"}]}]}] </script> </div> </div> </div> </div> </div> </div> </div> </div> </header> <main class="container responsivegrid cmp-container-full-width aem-GridColumn aem-GridColumn--default--12"> <div id="main-content" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="container responsivegrid cmp-container-full-width aem-GridColumn aem-GridColumn--default--12"> <div id="container-40a3f8a236" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="verticalspacer cmp-verticalspacer--medium aem-GridColumn aem-GridColumn--default--12"><div class="cmp-verticalspacer" data-cmp-is="verticalspacer"> </div> </div> <div class="container responsivegrid cmp-container-1440-gutters aem-GridColumn aem-GridColumn--default--12"> <div id="container-4ba5afb8cf" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="title cmp-title__align-center cmp-title__darkcolor-blue aem-GridColumn aem-GridColumn--default--12"> <div data-cmp-data-layer="{"title-02eedfed91":{"@type":"dentaquest/components/title","repo:modifyDate":"2023-06-07T14:38:15Z","dc:title":"Help us fight fraud"}}" id="title-02eedfed91" class="cmp-title"> <h1 class="cmp-title__text">Help us fight fraud</h1> </div> </div> <div class="text aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--10 aem-GridColumn--offset--default--1"> <div data-cmp-data-layer="{"text-2ab9998686":{"@type":"dentaquest/components/text","repo:modifyDate":"2023-06-18T21:29:14Z","xdm:text":"<p>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.</p>\r\n"}}" id="text-2ab9998686" class="cmp-text"> <p>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.</p> </div> </div> <div class="verticalspacer aem-GridColumn aem-GridColumn--default--12"><div class="cmp-verticalspacer" data-cmp-is="verticalspacer"> </div> </div> <div class="text aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0"> <div data-cmp-data-layer="{"text-2ae8fbc5df":{"@type":"dentaquest/components/text","repo:modifyDate":"2023-06-07T15:02:35Z","xdm:text":"<h2>What is fraud?</h2>\r\n<p>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.</p>\r\n<h2>You can make a difference.</h2>\r\n<p>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.</p>\r\n<h2>Information to review:</h2>\r\n<ul>\r\n<li>Name and address of the provider's office</li>\r\n<li>Date(s) of service</li>\r\n<li>Type and number of the procedure(s) provided</li>\r\n<li>Fees charged and the amount of co-payment that was collected</li>\r\n<li>Fraud leaves traces, and recognizing those traces requires the efforts of all of us.<br>\r\n&nbsp;</li>\r\n</ul>\r\n<h2>Examples of fraudulent practices:</h2>\r\n<ul>\r\n<li>Billing for services not provided</li>\r\n<li>Changing the date(s) of service to gain payment</li>\r\n<li>Inaccurate billing of services</li>\r\n<li>Waiving patient's co-payment and/or deductible</li>\r\n<li>Billing for a covered service when a non-covered service was performed</li>\r\n<li>Individuals who use someone else鈥檚 identification card</li>\r\n<li>Subscriber/members or provider offices that conceal other insurance coverage</li>\r\n</ul>\r\n"}}" id="text-2ae8fbc5df" class="cmp-text"> <h2>What is fraud?</h2> <p>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.</p> <h2>You can make a difference.</h2> <p>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.</p> <h2>Information to review:</h2> <ul><li>Name and address of the provider's office</li><li>Date(s) of service</li><li>Type and number of the procedure(s) provided</li><li>Fees charged and the amount of co-payment that was collected</li><li>Fraud leaves traces, and recognizing those traces requires the efforts of all of us.<br /> 聽</li></ul> <h2>Examples of fraudulent practices:</h2> <ul><li>Billing for services not provided</li><li>Changing the date(s) of service to gain payment</li><li>Inaccurate billing of services</li><li>Waiving patient's co-payment and/or deductible</li><li>Billing for a covered service when a non-covered service was performed</li><li>Individuals who use someone else鈥檚 identification card</li><li>Subscriber/members or provider offices that conceal other insurance coverage</li></ul> </div> </div> <div class="verticalspacer aem-GridColumn aem-GridColumn--default--12"><div class="cmp-verticalspacer" data-cmp-is="verticalspacer"> </div> </div> </div> </div> </div> <div class="container responsivegrid cmp-container-1440-gutters aem-GridColumn aem-GridColumn--default--12"> <div id="container-4332dfe659" class="cmp-container" style="background-color:#f6f6f6;"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="verticalspacer cmp-verticalspacer--small aem-GridColumn aem-GridColumn--default--12"><div class="cmp-verticalspacer" data-cmp-is="verticalspacer"> </div> </div> <div class="title cmp-title__align-center aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--8 aem-GridColumn--offset--default--2"> <div data-cmp-data-layer="{"title-fbecc150af":{"@type":"dentaquest/components/title","repo:modifyDate":"2023-06-18T21:28:19Z","dc:title":"To report suspected fraud, please use one of the following options:"}}" id="title-fbecc150af" class="cmp-title"> <h3 class="cmp-title__text">To report suspected fraud, please use one of the following options:</h3> </div> </div> <div class="verticalspacer cmp-verticalspacer--small aem-GridColumn aem-GridColumn--default--12"><div class="cmp-verticalspacer" data-cmp-is="verticalspacer"> </div> </div> <div class="accordion panelcontainer aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--8 aem-GridColumn--offset--default--2"> <div id="accordion-9324d7aa91" class="cmp-accordion" data-cmp-is="accordion" data-cmp-data-layer="{"accordion-9324d7aa91":{"shownItems":[],"@type":"dentaquest/components/accordion","repo:modifyDate":"2023-06-07T14:49:24Z"}}" data-cmp-single-expansion data-placeholder-text="false"> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-9324d7aa91-item-218c044a69":{"@type":"dentaquest/components/accordion/item","dc:title":"For Medicare Advantage/Medicaid"}}" id="accordion-9324d7aa91-item-218c044a69"> <h3 class="cmp-accordion__header"> <button id="accordion-9324d7aa91-item-218c044a69-button" class="cmp-accordion__button" type="button" aria-controls="accordion-9324d7aa91-item-218c044a69-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">For Medicare Advantage/Medicaid</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-9324d7aa91-item-218c044a69-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-9324d7aa91-item-218c044a69-button"><div class="container responsivegrid"> <div id="container-218c044a69" class="cmp-container"> <div class="aem-Grid aem-Grid--8 aem-Grid--default--8 "> <div class="text aem-GridColumn aem-GridColumn--default--8"> <div data-cmp-data-layer="{"text-8f8850f0c4":{"@type":"dentaquest/components/text","repo:modifyDate":"2023-06-19T19:48:22Z","xdm:text":"<p><b>Fraud Hotline: </b>800-237-9139<br>\r\n<b>Anonymous Hotline: </b>866-737-3559</p>\r\n<p><a title=\"Report Fraud Form - Medicare\" href=\"/content/dam/dentaquest/en/footer/report-fraud-form.pdf\" target=\"_blank\">Medicare Advantage/Medicaid Form</a></p>\r\n<p><b>Mail it to:</b><br>\r\n</p>\r\n<p>DentaQuest<br>\r\nPO Box 2906<br>\r\nMilwaukee, WI 53201-2906</p>\r\n<p>Or print the Fraud &amp; Abuse Form and fax it to: 262-241-7366<br>\r\n</p>\r\n"}}" id="text-8f8850f0c4" class="cmp-text"> <p><b>Fraud Hotline: </b>800-237-9139<br /> <b>Anonymous Hotline: </b>866-737-3559</p> <p><a title="Report Fraud Form - Medicare" href="/content/dam/dentaquest/en/footer/report-fraud-form.pdf" target="_blank" rel="noopener noreferrer">Medicare Advantage/Medicaid Form</a></p> <p><b>Mail it to:</b><br /> </p> <p>DentaQuest<br /> PO Box 2906<br /> Milwaukee, WI 53201-2906</p> <p>Or print the Fraud & Abuse Form and fax it to: 262-241-7366<br /> </p> </div> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-9324d7aa91-item-cfa0f19d8a":{"@type":"dentaquest/components/accordion/item","dc:title":"For Group Plans"}}" id="accordion-9324d7aa91-item-cfa0f19d8a"> <h3 class="cmp-accordion__header"> <button id="accordion-9324d7aa91-item-cfa0f19d8a-button" class="cmp-accordion__button" type="button" aria-controls="accordion-9324d7aa91-item-cfa0f19d8a-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">For Group Plans</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-9324d7aa91-item-cfa0f19d8a-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-9324d7aa91-item-cfa0f19d8a-button"><div class="container responsivegrid"> <div 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href="/content/dam/dentaquest/en/footer/report-fraud-form-group.pdf" target="_blank" rel="noopener noreferrer">Group / Individual Form</a></p> <p><b>Mail it to:</b><br /> </p> <p>DentaQuest<br /> PO Box 2906<br /> Milwaukee, WI 53201-2906</p> <p>Or print the Fraud & Abuse Form and fax it to:聽617-886-1488<br /> </p> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="verticalspacer cmp-verticalspacer--medium aem-GridColumn aem-GridColumn--default--12"><div class="cmp-verticalspacer" data-cmp-is="verticalspacer"> </div> </div> </div> </div> </div> <div class="verticalspacer aem-GridColumn aem-GridColumn--default--12"><div class="cmp-verticalspacer" data-cmp-is="verticalspacer"> </div> </div> </div> </div> </div> <div class="experiencefragment aem-GridColumn aem-GridColumn--default--12"> <div id="experiencefragment-75193a5f69" class="cmp-experiencefragment cmp-experiencefragment--enroll"> <div id="container-efc20d0c4b" class="cmp-container"> <div class="aem-Grid 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1200w,/adobe/dynamicmedia/deliver/dm-aid--e3e1b264-ba88-4d9e-8ea4-934816d6ccf4/family-excited-about-oral-health.jpg?quality=85&preferwebp=true&width=1600 1600w" loading="lazy" class="cmp-image__image" itemprop="contentUrl" width="500" height="554" alt="Preventistry Pulse"/> </div> </div> </div> </div> </div> <div class="container responsivegrid cmp-enroll-text__container aem-GridColumn aem-GridColumn--default--12"> <div id="container-f633c7e3ab" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="title cmp-title__align-left aem-GridColumn aem-GridColumn--default--12"> <div data-cmp-data-layer="{"title-faa9f5e6e5":{"@type":"dentaquest/components/title","repo:modifyDate":"2023-05-23T16:17:58Z","dc:title":"PREVENTISTRY PULSE"}}" id="title-faa9f5e6e5" class="cmp-title"> <h3 class="cmp-title__text">PREVENTISTRY PULSE</h3> </div> </div> <div class="text aem-GridColumn aem-GridColumn--default--12"> <div 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data-cmp-src="/content/experience-fragments/dentaquest/us/en/site/footer/master/_jcr_content/root/container_1923334321/container/image.coreimg{.width}.svg/1685555758937/dq-sunlife-logo.svg" data-cmp-filereference="/content/dam/dentaquest/en/global-assets/logos/DQ Sunlife Logo.svg" id="image-181690671b" data-cmp-data-layer="{"image-181690671b":{"@type":"dentaquest/components/image","repo:modifyDate":"2023-05-31T17:55:58Z","dc:title":"DentaQuest Logo","xdm:linkURL":"/en","image":{"repo:id":"16e833d6-8a35-404f-b829-e3760e914308","repo:modifyDate":"2023-05-09T16:57:51Z","@type":"image/svg+xml","repo:path":"/content/dam/dentaquest/en/global-assets/logos/DQ Sunlife Logo.svg"}}}" data-cmp-hook-image="imageV3" class="cmp-image" itemscope itemtype="http://schema.org/ImageObject"> <a class="cmp-image__link" data-cmp-clickable href="/en"> <img src="/content/experience-fragments/dentaquest/us/en/site/footer/master/_jcr_content/root/container_1923334321/container/image.coreimg.svg/1685555758937/dq-sunlife-logo.svg" loading="lazy" class="cmp-image__image" itemprop="contentUrl" alt="DentaQuest a Sun Life company Logo" title="DentaQuest Logo"/> </a> <meta itemprop="caption" content="DentaQuest Logo"/> </div> </div> <div class="text aem-GridColumn aem-GridColumn--default--3"> <div data-cmp-data-layer="{"text-ac55e5a952":{"@type":"dentaquest/components/text","repo:modifyDate":"2023-05-31T17:13:22Z","xdm:text":"<p>96 Worcester Street<br>\r\nWellesley Hills, Massachusetts<br>\r\n02481</p>\r\n"}}" id="text-ac55e5a952" class="cmp-text"> <p>96 Worcester Street<br /> Wellesley Hills, Massachusetts<br /> 02481</p> </div> </div> <div class="container responsivegrid cmp-global-footer-social-media aem-GridColumn aem-GridColumn--default--3"> <div id="container-8241373bed" class="cmp-container"> <div class="aem-Grid aem-Grid--3 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data-cmp-data-layer="{"text-6b85d2baac":{"@type":"dentaquest/components/text","repo:modifyDate":"2023-06-19T21:25:40Z","xdm:text":"<p><b><a href=\"/content/dentaquest/us/en/who-we-serve.html\" title=\"Who We Serve\">Who We Serve</a></b></p>\r\n<p><a href=\"/content/dentaquest/us/en/who-we-serve/health-plans.html\" title=\"Health Plans\">Health Plans</a></p>\r\n<p><a href=\"/content/dentaquest/us/en/who-we-serve/state-agencies.html\" title=\"State Agencies\">State Agencies</a></p>\r\n<p><a href=\"/content/dentaquest/us/en/who-we-serve/employer-groups.html\" title=\"Employer Groups\">Employer Groups</a></p>\r\n<p><a href=\"/content/dentaquest/us/en/who-we-serve/brokers.html\" title=\"Brokers\">Brokers</a></p>\r\n"}}" id="text-6b85d2baac" class="cmp-text"> <p><b><a href="/en/who-we-serve" title="Who We Serve">Who We Serve</a></b></p> <p><a href="/en/who-we-serve/health-plans" title="Health Plans">Health Plans</a></p> <p><a href="/en/who-we-serve/state-agencies" title="State Agencies">State Agencies</a></p> <p><a href="/en/who-we-serve/employer-groups" title="Employer Groups">Employer Groups</a></p> <p><a href="/en/who-we-serve/brokers" title="Brokers">Brokers</a></p> </div> </div> <div class="text aem-GridColumn--default--9 aem-GridColumn"> <div data-cmp-data-layer="{"text-bc39c475c2":{"@type":"dentaquest/components/text","repo:modifyDate":"2023-06-20T18:40:46Z","xdm:text":"<p><b><a href=\"/content/dentaquest/us/en/what-we-offer.html\" title=\"What We Offer\">What We Offer</a></b></p>\r\n<p><a title=\"Medicaid/CHIP solutions\" href=\"/content/dentaquest/us/en/what-we-offer/medicaid-chip-solutions.html\">Medicaid/CHIP<br>\r\n Solutions</a></p>\r\n<p><a title=\"Medicare Advantage Solutions\" href=\"/content/dentaquest/us/en/what-we-offer/medicare-advantage-solutions.html\">Medicare Advantage<br>\r\n Solutions</a></p>\r\n<p><a title=\"Commercial Solutions\" href=\"/content/dentaquest/us/en/what-we-offer/commercial-solutions.html\">Commercial<br>\r\n Solutions</a></p>\r\n<p><a href=\"/content/dentaquest/us/en/what-we-offer/dental-insurance-marketplace-solutions.html\" title=\"Marketplace Solutions\">Marketplace<br>\r\n Solutions</a></p>\r\n<p><a title=\"Dental Network\" href=\"/content/dentaquest/us/en/what-we-offer/network.html\">Dental Network</a></p>\r\n<p><a href=\"/content/dentaquest/us/en/what-we-offer/vision-solutions.html\">Vision Solutions</a></p>\r\n<p><a title=\"Systems and Technology\" href=\"/content/dentaquest/us/en/what-we-offer/systems-and-technology.html\">Systems and<br>\r\n Technology</a></p>\r\n"}}" id="text-bc39c475c2" class="cmp-text"> <p><b><a href="/en/what-we-offer" title="What We Offer">What We Offer</a></b></p> <p><a title="Medicaid/CHIP solutions" href="/en/what-we-offer/medicaid-chip-solutions">Medicaid/CHIP<br /> Solutions</a></p> <p><a title="Medicare Advantage Solutions" href="/en/what-we-offer/medicare-advantage-solutions">Medicare Advantage<br /> Solutions</a></p> <p><a title="Commercial Solutions" href="/en/what-we-offer/commercial-solutions">Commercial<br /> Solutions</a></p> <p><a href="/en/what-we-offer/dental-insurance-marketplace-solutions" title="Marketplace Solutions">Marketplace<br /> Solutions</a></p> <p><a title="Dental Network" href="/en/what-we-offer/network">Dental Network</a></p> <p><a href="/en/what-we-offer/vision-solutions">Vision Solutions</a></p> <p><a title="Systems and Technology" href="/en/what-we-offer/systems-and-technology">Systems and<br /> Technology</a></p> </div> </div> <div class="text aem-GridColumn--default--9 aem-GridColumn"> <div data-cmp-data-layer="{"text-b3388dec3f":{"@type":"dentaquest/components/text","repo:modifyDate":"2023-06-20T18:42:58Z","xdm:text":"<p><b><a href=\"/content/dentaquest/us/en/about-us.html\" title=\"About Us\">About Us</a></b></p>\r\n<p><a href=\"https://sunlife.wd3.myworkdayjobs.com/Experienced-Jobs\" target=\"_blank\" title=\"Careers\" rel=\"noopener noreferrer\">Careers</a></p>\r\n<p><a 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