Complete this form to report possible fraudulent activity. Provide all known details so Delta Dental of South Dakota (Delta Dental) is able to thoroughly investigate your concerns. Insufficient information may result in our inability to complete an investigation. All reports submitted in good faith will be investigated to the best of our ability. Please complete form below to submit your concerns to Delta Dental. If you prefer to email or mail the information, click here to download a form.

Questions or wish to call to report the situation: Compliance Manager at (605) 224-7345 or toll-free 800-827-3961


Today's Date: 03/22/2019
Contact Information (Optional) – You may anonymously submit this report; however the ability to contact you with follow-up questions is valuable and sometimes necessary for a thorough investigation. Provide as much detail as possible, including dates. If you provide contact information, we will do our best to protect your confidentiality. Delta Dental enforces a non-retaliation policy to protect individuals from retaliation when he/she reports potential fraud concerns to us in good faith.
Name:
Phone Number:
Email Address:
Description of the suspected fraud activity (Provide as much detail as possible):
Name (s) of individuals involved in the suspected fraudulent activity (if known):
Primary Person/Business:
Name: AddressCityState
Other Party Involved:
Name: AddressCityState
How did you become aware of the incident (e.g., witnessed firsthand, heard it from another person, etc.)?
Have you notified anyone else (e.g. supervisor, law enforcement, outside agency, etc.) of this suspected activity?