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Healthcare Fraud And You
The National Healthcare Anti-Fraud Association estimates that fraud costs Americans over $50 billion every year. Altered billing of services, forged documents and computer technology are used illegally to collect billions of dollars from you and health insurers.
Healthcare Fraud And How It Affects You
• Healthcare fraud costs Americans an estimated $54 billion dollars annually.
• Healthcare fraud is committed by a multitude of individuals including medical providers, members as well as pharmacies.
• Healthcare fraud increases the cost of healthcare for everyone
• Healthcare fraud jeopardizes the overall healthcare of consumers
Common Types Of Healthcare Fraud
Services Not Rendered
Billing for services that were not rendered to the member
Misrepresentation of Services
Billing for a covered service when an uncovered service was actually rendered
Medically Unnecessary Services
Billing for services that are not necessary for the treatment of the member
Upcoding Services
Billing for services that are more complex and at a higher reimbursement than the actual service provided
Unbundling Service
Billing for services separately instead of billing the code that includes multiple services
Misrepresentation of Identity (member/provider)
Falsely receiving or billing for services under a covered member's identity
Doctor Shopping
Receiving various narcotic medications from a multitude of physicians through deceit
Misrepresentation of Eligible Dependents
Maintaining eligibility for or adding an individual who does not legally qualify for benefits under the Program
What You Can Do To Combat Healthcare Fraud?
• Protect your health benefits identification card as you do your credit card
• Review your Explanation of Benefit (EOB) summary to ensure that the services billed were actually rendered
• Be selective in sharing your health insurance information
• Be cautious of free medical exams, copayment/coinsurance waivers and advertisements stating "covered by insurance"
• Provide timely eligibility changes
How Do I Report Suspected Healthcare Fraud?
Call the FEP Fraud Hotline @ 1.800.337.8440
Or
Write to:
United States Office of Personnel Management
Office of Personnel Management
Office of the Inspector General Fraud Hotline
1900 E Street, NW
Washington, DC 20005
Or
Contact Your Local Plan
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