I am writing in regard to the article "The War on Fraud and Its Effect on Dentistry" (February JADA).
I believe that a major portion of medical and dental fraudulent claims could be controlled by simply requiring the patient or patient’s representative to be allowed or even required to review and approve the service entries on the claim form before it can be sent to the third party for consideration of payment.
This would require that the provider fill out the claim form before, instead of after, the insured has signed the form. The insured is customarily required to sign a blank form at a time when he or she has no idea what will be submitted. I think this is just backwards and leaves the door open for "extra" entries that could be associated with services actually provided but not actually provided.
I have followed this procedure in my office for more than 25 years and have not found it to be an administrative headache as some will probably claim.
At least I feel good that my patients know exactly what was submitted and can either know that it matches with their recollection of the services received or can call the office and get an explanation. This is not possible when the provider is allowed to fill in the form and send it without any kind of cross-check.
I do not see that the medical and dental fraud situation will ever get any better unless a system is in place to provide someone the opportunity to check on what is being submitted. Who else is better qualified than the person who has the insurance?
