The mission of
Delta Dental of New Jersey's Special Investigations
Unit is: To effectively and efficiently
detect and deter overbilling and/or fraudulent activity and to recover
and stop overpayments made by the corporation.
What is
healthcare fraud and abuse?
Healthcare fraud
is defined as an intentional deception or
misrepresentation an individual or entity makes
regarding healthcare, knowing that the deception
could result in some unauthorized benefit or
reimbursement.
Abuse is defined
as incidents or practices of providers or others
that are inconsistent with accepted business or
financial practices and which result in
unnecessary cost to an insurance carrier.
The Special Investigations Unit (SIU)
investigates suspected fraud and abuse of dental
insurance. You can report suspected fraud to us
in one of five ways:
-
Call our fraud hotline: 888-696-3262
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E-mail: reportfraud@deltadentalnj.com
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Fax: 973-944-4573
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Write to: Delta Dental of New
Jersey
Special Investigations Unit
1639 Route 10
Parsippany, New Jersey 07054
-
Download fraud reporting form
(link to follow)
PLEASE NOTE:
NEW REVISIONS TO DELTA DENTAL'S BYLAWS and RULES
AND REGULATIONS
Participating providers should review Article XIV, Sections 5-8 of
the revised Bylaws and Sections 1, 4, 8, and 16
of the revised Rules and Regulations.
Among other
changes, as of February 1, 2007 a dentist is
expressly prohibited from collecting any fee for
services contained on a claim submitted to Delta
Dental on which false information has been
provided (exception relating to certain
typographical errors).
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