The administrative team is responsible for accurate claims submissions. The insurance company relies on the dental team to submit correct forms and to collect the remainder of fees as prescribed by the plan. A team member who falsely submits a claim because their employer requested them to do so, cannot escape liability by pleading ignorance. Some examples of insurance falsification include:
Submitting claims for treatment not provided, including coding a procedure differently to receive a higher fee. For example, submitting a simple extraction coded as a surgical extraction.
Changing fees on a claim form to receive a higher payment.
Disregarding a deductible or co-payment, accepting only the insurance payment and writing off the difference.