Health care fraud affects all of us. For members, health care fraud results in higher premiums and out-of-pocket costs and reduced benefits. For employers, fraud drives up the costs of doing business and providing health plans to employees.
- Protect Yourself from Health Care 欺诈
- Identify Provider and Member 欺诈
- Be Aware of 欺诈, Waste, and Abuse Schemes
Protect Yourself from Health Care 欺诈
Ask your doctor about the services you receive, such as:
- Talk to your doctor if a treatment plan seems questionable or excessive. If you don’t agree with the plan, get a second opinion.
- Be careful about disclosing your insurance information over the phone or online. Protect your HMSA membership card as if it were a credit card.
Compare your HMSA Report to Member and/or your medical bills with your records. 问问你自己:
- Are the dates of service correct?
- Were the services actually performed?
- Is the cost-share数量 correct?
- Be wary of ads or promotions that offer free tests, treatment, or services especially when you’re asked to provide insurance information or a copy of your HMSA membership card.
- Let HMSA know if a provider waives copayments or bills more than the cost-share数量.
- Report any suspicions of fraud to HMSA.
欺诈 Carries Other Implications for Victims
- Be subjected to unnecessary or unsafe medical procedures or treatments.
- Discover that your health plan benefits have been unexpectedly exhausted.
- Have incorrect information added to your medical records.
- Receive the wrong medical treatment.
- Unexpectedly fail a physical exam for employment.
- Be denied insurance as a result of medical identity theft.
Identify Provider and Member 欺诈
知道要寻找什么. Here are examples of provider and member health care fraud that you should report to HMSA.
Provider fraud can include:
- Billing for services that weren’t performed.
- Falsifying a patient’s diagnosis to justify tests, surgeries, or other procedures that aren’t medically necessary.
- Misrepresenting procedures performed to obtain payment for noncovered services, 比如整容手术.
- Upcoding, which means billing for a more-costly service than the one that was performed.
- Billing each stage of a procedure as if they were separate procedures.
- Accepting kickbacks for patient referrals.
- Waiving patient copayments or deductibles and overbilling the health plan.
- Billing for services that were offered or advertised as free.
- Billing for services provided to their immediate family members.
- Using someone else’s health plan benefits for themselves.
- Not removing someone from a health plan when they’re no longer eligible (e.g., a former spouse or children who are no longer dependents).
- Adding someone to their policy who isn’t eligible (e.g., grandchildren or over-aged dependents).
- visiting several doctors (“doctor shopping”) to obtain multiple prescriptions, often for controlled substances.
If you suspect health care fraud or abuse, please report it:
- 在线: 提交 安全报告
通过电话. Use HMSA’s confidential fraud hotline:
- 电子邮件: 欺诈&Abuse@thedublinproject.com
- 传真: 808-948-6450
HMSA Special Investigations Unit
Be Aware of 欺诈, Waste, and Abuse Schemes
Medication and Medical Supplies 欺诈
If you receive medications or supplies in the mail that you or your doctor didn’t order, you might be the target of a fraud scheme.
- Return any medications or medical supplies that you receive if you didn’t order them.
- Report the company to HMSA Special Investigations Unit.
全国信誉第一的网投平台 may bill insurers for services they’ve never rendered.
- Review all Reports to Member issued for your HMSA plan.
- 全国信誉第一的网投平台 a Customer Relations representative if you notice questionable charges or provider names you don’t recognize.