Sometimes fraud is easy to spot and other times it is less clear, but fraud always leaves traces. Here are just a few examples of fraudulent practices:

• Patients or dental offices that hide other insurance coverage information
  
  
• Individuals who use someone else’s identification number
  
  
• Dental offices that submit a claim for a covered service, when actually a non-covered service was done
  
  
• Patients who ask the dental office to bill with different dates of service

Definitions of waste, abuse and fraud:

WASTE means any practices that allow careless spending and/or inefficient use of resources under the Texas Dental CHIP.

ABUSE means provider practices that are inconsistent with sound fiscal, business or medical practices and result in an unnecessary cost or in reimbursement for services that are not medically necessary or do not meet professionally recognized standards for heath care.

FRAUD means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable federal or state law.

Anyone who sees something suspicious can report waste, abuse or fraud. To make a report, please fill out our WAF form. Click here for a form.