How to Report Dental Insurance Fraud in Your Office in Phoenix, AZ

Medical (including dental) insurance fraud is a crime that in Arizona can result in up to 10 years in jail, a fine of up to $150,000, and a civil penalty of up to $5,000 for each violation. Undetected medical and dental insurance fraud costs everyone in higher premiums and tax dollars. In Arizona, report suspected medical or dental insurance fraud to the Arizona Department of Insurance Fraud Unit.

Things You'll Need

• Computer, fax machine or telephone

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Instructions

• 1

  Report suspected dental insurance fraud in Arizona by downloading the Arizona Department of Insurance's Fraud Referral form available at id.state.az.us/fraud.html.

• 2

  Fill out the form according to the instructions on the back, where you also will find the codes the form requires.

  The codes that would apply to dental insurance fraud would be Reason for Suspicion Codes, Policy Type Codes, Loss Type Codes, and Role Codes. The reasons for suspicion in a dental insurance fraud case include QB: questionable billing; MC: multiple claims; ML: medical provider/lawyer relationship; MP: medical provider. The policy type could be DEVI: dental/vision; MAME: major medical; ACHE: accident/health/disability, or any of the other medical or work-related policies. Loss type codes include items such as HOSP: hospitalization; SMLX: surgical care/medical care/lab/X-ray; and PRES: Prescription. Role codes include MS: dentist; MG: radiologist; and MZ: office administrator.

  The form asks you to name the claimant and the claim made on that person's behalf. File a separate form for each claim number you are asking the Arizona Department of Insurance to investigate.

• 3

  Mail the completed form or forms to ADOI--Fraud Unit, 2910 N. 44th St., #210, Phoenix, AZ 85018, or fax it to 602-912-8419. This form is required if you are an insurance company reporting suspected fraud.

• 4

  Write to the Arizona Department of Insurance Fraud Unit if you are an individual reporting suspected dental insurance fraud and do not want to use the form. Give as much of the information called for on the form as you can, including the suspect's name, date of birth, Social Security number. You do not need to figure out the form's codes. Mail your letter to ADOI--Fraud Unit, 2910 N. 44th St., #210, Phoenix, AZ 85018, or fax it to 602-912-8419. You also may call 602-364-2140 to report suspected dental insurance fraud.