About our Special Investigations Unit (SIU)

Delta Dental’s mission is to provide quality dental coverage to its subscribers/members and their dependents, and has done so since 1971. Since 1981, we have had an ongoing program of in-office reviews performed for dentists who submit claims to Delta Dental of New Jersey.

Since 1971, it has been Delta Dental’s mission is to provide quality dental coverage to its subscribers/members and their dependents. 

Delta Dental’s Special Investigations Unit consists of a team of investigators and support staff with diverse educational and professional backgrounds in dental claims processing, law and public policy.

According to NJ state law, all SIU investigators must have at least one of the following:

  • An associate's degree along with two years of insurance-related work experience
  • A bachelor's degree
  • A minimum of four years of experience of  insurance-related work experience
  • A minimum of five years of law enforcement experience

In addition, Delta Dental of New Jersey also utilizes customer service agents, dental consultants, dental consultants and underwriters, to assist when necessary in our investigations.

Responsibilities of the Special Investigations Unit:

  • Analyze records and claims to identify evidence of misrepresentation regarding claim submissions
  • Communicate with patients to determine if any misrepresentation occurred
  • Conduct reviews of claims, treatment records, financial records, and related documentation for both insured and uninsured patients
  • Receive written and verbal correspondence regarding suspicious claims and identify an appropriate course of action
  • Report fraud to appropriate state agencies and bureaus
  • Train Delta Dental associates on fraud prevention

Since 1983, The State of New Jersey has had an Insurance Fraud Prevention Act in effect. Initially health insurance fraud was considered a civil offense, but since 1998, it is now a criminal offense and carries significant penalties.

Insurance carriers conducting business in New Jersey are required to report all reasonable suspicions of fraud. Additionally, health and auto insurance companies are required by the State of New Jersey to provide anti-fraud training to claims processing and underwriting staff, and to retain Special Investigations Units.