Dental fraud: an introduction.

A manager of a dental benefits program defines fraud and abuse in the dental context. Such practices may cost as much as four billion dollars annually and have a damaging effect on the trust the profession places in the profession and on the way dentists relate to each other.

The war on fraud and its effect on dentistry.

The fraudulent actions of a disreputable few people in the health care industry have caused enormous losses to government and private health care payers. Fraud can take a number of forms, but usually is based on some form of deceit. In response, law enforcement efforts have been aided by a number of recent anti-fraud statutes and significant new resources. The challenge to dentistry is to ensure that legitimate efforts to fight fraud do not unduly burden practitioners, the vast majority of whom are honest.

Recognizing the symptoms of employee fraud.

Unlike crimes that leave easily detectable physical evidence, employee fraud may be difficult to detect because often only symptoms of such crimes are readily apparent, and the symptoms may or may not signal actual fraud. This article discusses six categories of symptoms that indicate fraud may have been committed by an employee, and presents a case study example to illustrate symptoms auditors and financial managers should investigate.