Dental insurance fraud, waste, and abuse impacts everyone by driving up the costs of dental coverage for New Mexico employers, dental offices, and patients.

What is fraud, waste, and abuse?

Fraud is a crime when any person makes an intentional deception or misrepresentation of a material fact with knowledge that the deception could result in unauthorized or illegitimate benefit or payment from Delta Dental of New Mexico.

Abuse are practices that are inconsistent with sound fiscal, business, or dental practice that result in unnecessary costs to or the reimbursement for dental services by Delta Dental of New Mexico that are not medically necessary, violate an agreement or certificate of coverage, or fail to meet professionally recognized standards for dental health care.

Waste is the overutilization of services and other practices that, directly or indirectly, result in unnecessary costs to Delta Dental of New Mexico and the misuse of resources.

What can you do as a patient?

• Protect your Delta Dental benefits card like your credit card. Don’t let anyone borrow or use your card. If your card is lost or stolen, contact Customer Service right away at 1-877-395-9420 or customerservice@deltadentalnm.com.
• Protect yourself from identity theft.
• Look carefully at your Explanation of Benefits (EOB) that you receive. Be sure that the date, service, and dentist information is accurate. If something does not seem right, call the dental office for an explanation. Call Customer Service at 1-877-395-9420 if you need help understanding the EOB.

What can you do as a dental office?

• Always disclose any discounts, coupons, or waivers of copay.
• File claims timely and accurately. Never alter a date or file a misleading treatment to maximize a patient’s benefits.
• Review claim forms before submitting. Ensure that the treatment in the patient’s clinical notices is accurately reflected on the claim form.
• Ensure that the dentist listed on the claim form as the treating dentist is the one who performed the patient’s services.

Reporting fraud, waste, and abuse

Contact us immediately if you suspect someone of committing fraud, waste, or abuse by calling our Anti-Fraud Hotline at 1-800-524-0147. You can remain anonymous or share your contact information and request that your name not be used.

You can also complete and submit the Fraud or Abuse Complain Form below. Please provide as much detail as possible of the incident or services.

You may find more information on the New Mexico Office of the Superintendent of Insurance’s Insurance Fraud webpage at: www.osi.state.nm.us/pages/bureaus/criminal/resources/report-fraud or calling 1-877-807-4010.