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Health care fraud is a crime. Fraud is committed when a provider or patient intentionally submits false or misleading information to a health plan for use in determining the amount of health care benefits payable. As a Medical member, there are steps you can take to prevent health care fraud and to report suspected fraud .
Billing for non-covered items using codes for covered items
Billing for excessive or unnecessary medical services or supplies
Billing for a more costly service than the one that was actually performed
Altering billings or medical records.
Using unqualified personnel to perform treatments
Accepting kickbacks for referring patients
Waiving patient co-pays or deductibles
Using someone else's coverage or insurance card
Altering amounts charged on claim forms or prescription receipts
Enrolling someone not eligible (for example, divorced spouse) for coverage on a health plan
Including false information in an application for the purpose of obtaining coverage
Providing false information in order to receive medical coverage
Adding a person to an insurance policy that is not eligible for insurance coverage, by providing false information
Visiting different doctors to obtain multiple prescriptions
Whenever you receive a payment notice, review it for errors. For example, the payment notice shows what Medicare was billed for, what Medicare paid and what you owe. Make sure Medicare was not billed for health care services or medical supplies and equipment you did not receive.
Don't ever give out your Health Insurance Claim Number (on your Medicare card), except to your physician or other Medicare or Medicaid provider. Don't allow anyone, except appropriate medical professionals, to review your medical records or recommend services. Be careful in accepting Medicare services that are represented as being free.
If you suspect fraud there are several reporting options available to you. All reports are confidential and can be anonymous, if you choose. You are not required to include your name, address, or other identifying information.