With the expansion of dental coverage through Medicaid and Medicare Advantage plans, an ever-increasing number of dental claims have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and billing practices. When payers identify the activities they deem "suspicious" or "unusual" it provides insight on the provider side that can help them prevent such behavior through changes and updates to their compliance plans. Some odd or suspicious billing practices that increase the chance for investigation were identified as:
Fraud costs taxpayers millions of dollars and puts patients in
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