Report fraud and abuse

Fraud and abuse takes place every day and may go unnoticed. That’s why your plan has a Fraud and Abuse program to identify and detect fraud and abuse. If you suspect that the plan, a health care professional, or someone you know has been a victim of health care fraud, it’s important to report your concerns immediately.


What is fraud?

Fraud is when someone deliberately practices deceit in order to benefit from it. Some types of fraud are:

  • Being billed for services that you did not want or receive.
  • A provider discharging members from their care because of the member's health.
  • Giving or loaning an ID card to someone else so they can get medical or pharmacy services.
  • Someone other than you using your ID card.
  • Changing a prescription.
  • Giving false information to get medical or pharmacy services.


What is abuse?

Abuse is improper use of the benefits and/or services being provided. Some types of abuse are:

  • Billing for services under an incorrect benefit for increased reimbursement.
  • Hostile or rude behavior in a doctor's office, hospital or pharmacy.

 


What can I do to protect myself?

  • Report suspicious billing
    For claims questions, potential billing errors or provider disputes please contact a customer service representative at the phone number listed on your medical identification card.
  • Review your policy and benefit statements
    Review your policy, Explanation of Benefits (EOB) statements and any other paperwork you receive related to your coverage. 
  • Beware of "free" offers, including waiver of copay or coinsurance
    Offers of "free" services, including waiver of copay or coinsurance, are often fraud schemes designed to bill you and your plan illegally for thousands of dollars of treatments you never received. Do not give your policy number in exchange for getting a "free" consultation, or any other ‘free’ service.
  • Protect your health plan ID card like your credit card
    In the wrong hands, a Plan ID card is a license to steal. Don't give policy numbers to door-to-door salespeople or telephone solicitors. Never give your card to a friend to use for services.

 


How do I report fraud and abuse?

If you think you've been a victim of identity theft or fraud, call any of these numbers:

  • Call toll-free 1-800-MEDICARE (1-800-633-4227). TTY, call toll-free 1-877-486-2048, 24 hours a day, 7 days a week.
  • The Fraud Hotline of the HHS Office of Inspector General, toll-free at 1-800-HHS-TIPS (1-800-447-8477). TTY, call toll-free 1-800-377-4950. You can also email HHSTips@oig.hhs.gov.
  • The Federal Trade Commission's ID Theft Hotline toll-free at 1-877-438-4338 to make a report. TTY users, call toll-free 1-866-653-4261.

You can always remain anonymous.

 

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