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Protecting Against Billing Fraud

At Kool Smiles, we take our patients’ account information very seriously. We encourage all patients and staff to be able to recognize billing fraud in order to prevent it. Dental and medical bills can include a lot of codes and language that everyday consumers may not understand, and identifying fraud can be difficult.

Below are some things patients can watch out for in order to protect themselves.

Signs of Billing Fraud

Billing fraud can happen with both private insurance and Medicaid. Kool Smiles has compliance programs to observe, detect and remove instances of billing fraud within its network.  When patients receive a bill from the insurance company, they should look for these signs of insurance billing fraud before making a payment.

  1. Charges for services not performed, products never purchased or appointments that didn’t happen.
  2. Billing at higher rates than are authorized.
  3. Billing covered services or products as non-covered items.
  4. Billing for a more expensive procedure than the one that was actually performed.
  5. Separating one procedure into multiple steps and billing them all as individual procedures.
  6. Billing for a larger number of doses or quantity of products than were actually administered or used.
  7. Continuing to bill for rented equipment after it was returned.
  8. Double billing, or billing for the same service twice.
  9. Billing for an office visit when a patient is only there to pick up a prescription.
  10. Billing one visit on a single day as multiple visits over multiple days.
  11. Billing dentist rates for services that were performed by a dental assistant.
  12. Billing for premium prescription brands when only a generic brand was prescribed.
  13. Billing for unnecessary lab tests.

How to Protect Against Billing Fraud

It’s up to each patient to avoid becoming a victim of billing fraud. By taking just a few simple measures, patients can protect their wallets and peace of mind:

  • Obtain copies of billable items from the dentist after each appointment. Save them until the insurance company sends a bill in the mail, and then compare the two side by side.
  • Ask the dentist to explain what the different billing codes and language means. Dental bills can be difficult to interpret, so it’s important for patients to know what they’re reading.
  • Know what the dental insurance plan covers, what it doesn’t and when it’s due to expire. It’s easy to take advantage of people who aren’t familiar with their insurance plan.
  • Keep a record of when and what dental treatments were performed at the dentist.

Visiting the dentist is the best way to prevent dental decay, and paying attention to billing is the best way to prevent billing mistakes and fraud.

Kool Smiles is a dental network of more than 120 locations across the country. All Kool Smiles dental professionals are focused on providing excellent care and education around all things dental — from the actual care to the billing processes. Learn more about Kool Smiles today.