About our Special Investigations Unit (SIU)

Delta Dental’s Special Investigations Unit (SIU) consists of a team of investigators, each of whom has at least one of the following:

• A bachelor's degree
• An associate's degree plus a minimum of two years' experience with insurance-related employment
• A minimum of four years of experience with insurance-related employment
• A minimum of five years of law enforcement experience

Our SIU staff has a diverse educational and professional background relating to dental, claims processing, law, and public policy. We currently meet or exceed the Connecticut state requirements. Delta Dental of Connecticut also utilizes other staff such as dental consultants, customer service agents, underwriters, and claims processing professionals to assist in investigations.

The SIU is responsible for:

• Receiving written and verbal correspondence regarding suspicious claims and developing a course of action
• Conducting reviews of claims, treatment records, financial records, and other supporting documentation for both insured and uninsured patients
• Analysis of the records and claims to determine if there is evidence of misrepresentation regarding claim submissions
• Communicating with patients to determine if any misrepresentation occurred
• Reporting fraud to appropriate state agencies and bureaus
• Training Delta Dental associates on fraud prevention

The Connecticut Department of Insurance’s Fraud & Investigations unit promotes insurance fraud prevention, detection, and reporting through consumer outreach and education. The unit also provides assistance to insurer’s anti-fraud or special investigative units (SIU’s) and facilitates cooperation and communication among insurers, state and federal agencies, law enforcement, and insurance industry groups. The Fraud Unit coordinates anti-fraud efforts among, and offers assistance as appropriate to, the following entities or agencies: National Insurance Crime Bureau (NICB) local, state and federal law enforcement, and other state agencies such as Department of Public Health, Department of Consumer Protection and Department of Motor Vehicles.

Additionally, the unit reviews allegations of insurance fraud and makes referrals to other agencies or law enforcement for criminal prosecution as needed. Typical referrals include, among others, reports of arson, staged auto accidents, false reports of auto theft and improper medical billing.