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What does health and dental benefits fraud look like?

Some people have become involved in benefits fraud because it was suggested by someone they trust, such as a health and dental service provider, a coworker or others they know. Learn what it looks like so you can stop it.

Take this quiz to learn what it means to commit benefits fraud. Select ‘Yes’ if you believe the scenario counts as benefits fraud, or ‘No’ if you do not believe it is benefits fraud.

Frequently Asked Questions

Who commits health and dental benefits fraud?

Benefits fraud can be committed by health or dental service providers, plan members or both. You can become involved in benefits fraud without even knowing it. For example, a health or dental care provider could ask you to sign a blank claim form which they can use dishonestly later without your knowledge. If they do, you are involved in benefits fraud.

What are the consequences of health and dental benefits fraud?

You could lose your benefits, or your job. You could get a criminal record, be fined or be sent to jail.

What is health and dental benefits fraud?

Benefits fraud occurs when you intentionally submit false or misleading information to your insurance provider for the purpose of financial gain, and it can take many forms. Examples include (but are not limited to):

  • Billing for health or dental services that were never received
  • Submitting the same claim to multiple insurers to double your reimbursement
  • Letting someone not covered by your plan use your benefits.
How can you protect yourself from the consequences of health and dental benefits fraud?

Learning how to use your benefits appropriately and how to recognize benefits fraud can help you refuse it and report it. If you suspect your health or dental service provider, coworkers, or others you know are encouraging you to submit a fraudulent claim, or something just doesn’t feel right, report it to your employer or insurance provider immediately. Report fraud anonymously here: report benefits fraud