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Could Your Dental Billing Put You at Risk of a Fraud Accusation?

You have an impeccable track record for honest and reliable patient service, but did you know that your dental billing could be putting your practice at risk? Although you strive to be aware of everything that goes on in your office, the fact is, you have employees who are working on their own, logging work completed, filing insurance claims, and handling your business finances. Unless you spend every waking moment checking up on their work, you could be missing fraudulent activity. 

Working with an outside source like Dental Practice Enhancement to submit your dental billing can protect your practice from legal action and potentially catastrophic financial consequences. Our administrators are highly trained, and we have an unfailing commitment to honest practices. Contact us today to learn more about billing and our other services.

What Is Dental Fraud?

To qualify as dental fraud, an act must meet three requirements

  • Intent
  • Deception
  • Unlawful gain

Unfortunately, if an employee has the intent to deceive, a dentist can be held liable, even if he or she did not participate in the fraudulent activity. For instance, the ADA recounts one case in which a staff member was adding procedures that did not actually occur to their patients’ bills. The dentist himself was unaware of the activity and did not receive any money from it. Nonetheless, he was declared legally responsible and was convicted of a federal crime because the fraudulent bills were sent out using the US Postal Service.

Examples of Illegal Dental Billing and Fraud

Dental fraud can take many different forms, including:

  • Billing for treatments that never took place
  • Billing for a more expensive treatment than the one actually performed
  • Fraudulent reporting of dates of service: The date on a submitted claim must match the date on the clinical paperwork.
  • Reporting inaccurate diagnoses or changing insurance coding: Not only does this increase the total amount of the service being billed; it also increases the out-of-pocket cost for patients. 
  • Unbundling procedures: This occurs when a dental practice separates and charges for each individual step of a procedure. For instance, it would be fraudulent if, instead of simply charging for a dental filling, a practice charged for cleaning the tooth, prepping the tooth, fabricating the restoration, and placing the filling. 

Experienced Offsite Dental Billing Can Protect Your Practice 

Although it is important for dentists to be aware of what goes on in their practice and to be on the alert for signs of illegal or dishonest behavior, it is possible for fraud to go undetected for years. Once the alert is raised, however, it can cost a practice tens of thousands of dollars in legal fees and fines. 

That is why more dentists than ever are turning to third-party experts for their dental billing. Working with off-site professionals, they can rest easy, knowing that they never need to worry about illegal or fraudulent activity. Plus, dental billing specialists stay up-to-date with the latest changes in diagnostic and coding practices. Therefore, there is no risk that doctors will face an accusation of fraud due to employee error.

Contact Us to Outsource Your Dental Billing

Discover more about the services provided by Dental Practice Enhancement. Whether you simply want help with dental billing or you want to outsource all of your administrative tasks, we can design a solution to meet your needs. Call (833) DPE-FOR-U or contact us online.

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