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What You Should Know About Health Care Fraud, Waste & Abuse

Help keep yourself and your loved ones safe

Health care fraud, waste and abuse affects everyone in the U.S.1 So let’s make sure you know what it is, how to spot it and how to help us prevent it. What is it exactly? Well, fraud is when someone intentionally lies to a health insurance company, Medicaid or Medicare to get money. Waste is when someone overuses health services carelessly. And abuse happens when best medical practices aren’t followed, leading to expenses and treatments that aren’t needed.

Why It Matters

When health care professionals or any person engages in health care fraud, waste and abuse, it has an impact on you. Take a look at how this growing problem makes things harder for you and your loved ones by selecting the panels below.

Increased Costs


Losses due to fraud can put a big dent in your wallet

Identity Theft


Costs you time and money and can compromise your safety

Health Risks


Fraudulent medical history increases your health risks

Security Clearances


Past unresolved issues could become red flags

Health Care Fraud, Waste and Abuse Examples

Health care fraud, waste and abuse can take many forms, which makes it hard to spot. Here’s a breakdown of the most common types. Please select a tab to learn more.

Spotting Scams

Tackling health care fraud, waste and abuse takes team work. Here you’ll see how we can partner and combat it together. Our main priority is to keep you safe. So we keep a watchful eye on fraud, waste and abuse in all its forms. Some of the ways our investigative team fights scams include:

  • Looking carefully at claims and the information in them to spot red flags
  • Keeping a close eye on doctors’ billing patterns for weird or suspicious charges
  • Working with other health care companies to track suspicious activity
  • Partnering with law enforcement to investigate potential fraud
  • Training all our employees to spot unusual claims

How Can I Help?

You can help us spot scams and unusual activity tied to your health plan by understanding a few simple things:
Watch out for freebies. If you get offered free products or extra services, or you see ads that say “covered by insurance,” be careful.
 
Avoid identity theft. Don’t leave your ID card exposed, and report it if it’s lost or stolen.
 
Take a look at your bill. Unless a service is covered by a specific government program, such as Medicaid, confirm your insurance agent or broker sends your monthly payments to us.
Review your explanation of benefits (EOB). Your EOB is a snapshot of your doctor’s visit. When you receive it in the mail or access it online, make sure the services listed on it match the services you actually received. To learn more, watch the Understanding Your EOB video.

Report It

You’re our best ally when it comes to preventing health care fraud, waste and abuse.
 
If you think you or one of your dependents has been a victim of health care fraud, waste or abuse, report it by calling the Member Services number on the back of your ID card or use the button below to fill out and submit a report online.
 
 
Submit Report Online

Contact Us

If you prefer to call or report anonymously, contact us at your state’s designated fraud hotline: 
  • California: 1-888-231-5044
  • Colorado: 1-800-377-2227
  • Connecticut: 1-800-258-3258
  • Georgia: 1-800-831-8998
  • Indiana: 1-877-283-1524
  • Kentucky: 1-800-866-1186
  • Maine: 1-800-285-7424
  • Missouri: 1-888-451-1155
  • Nevada: 1-800-377-2227
  • New Hampshire: 1-800-203-3738
  • New York: 1-800-423-7283
  • Ohio: 1-800-848-9276
  • Virginia: 1-800-368-3580
  • Wisconsin: 1-800-544-3873
State not listed? Call: 1-866-847-8247
Sources:
1. National Health Care Anti-Fraud Association website: The Challenge of Health Care Fraud (accessed April 2017): nhcaa.org.
2. FBI archives website: Medicare Fraud Strike Force Charges 107 Individuals for Approximately $452 Million in False Billing (accessed April 2017): archives.fbi.gov/archives/neworleans/press-releases/2012/medicare-fraud-strike-force-charges-107-individuals-for-approximately-452-million-in-false-billing.
3. U.S. Department of State website: All About Security Clearances (accessed April 2017): state.gov/m/ds/clearances/c10978.htm.
4. HealthAffairs website: Reducing Waste in Health Care (accessed April 2017): healthaffairs.org.