Billing, Insurance and Reimbursement · CDA

Why is it considered fraudulent for a dentist to waive the patient’s co-payment without insurer approval?

  1. It automatically increases the insurance premiums charged to the patient
  2. The insurer pays assuming copay was collected, so waiving misstates cost
  3. It provides an overly generous benefit that harms the practice financially
  4. It is generally permitted whenever the patient states they cannot afford it
Show answer and explanation

Correct answer: The insurer pays assuming copay was collected, so waiving misstates cost

Waiving copays misrepresents the cost shared by the patient. Insurance coverage assumes copay is paid, so waiving it constitutes fraud.

Difficulty: Medium Question 18 of 20

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