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.
Health care fraud is defined as an intentional deception or misrepresentation an individual or entity makes regarding health care, 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 that 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 several ways:
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).