Examples of Fraud
Fraud can be committed by, and affect, stakeholders across every area of the health care system. Health care fraud is a serious crime that affects everyone’s health care and is a costly reality that we cannot afford to overlook. Health care fraud is a federal criminal offense punishable by up to 20 years in federal prison.
Most Common Types of Fraud
- billing for services not provided
- billing for more expensive services than were actually preformed, commonly known as upcoding
- performing medically unnecessary services solely for the purpose of reimbursement
- billing non-covered services (e.g., cosmetic) as other covered services
- prescription fraud and pharmaceutical diversion to include Medicare Part D
- providing false information during enrollment
- accepting bribes or kickbacks for patient referrals
- routinely waiving co-payments and/or deductibles
- medical identity theft
Things to Look Out For
- Review your claims at ibxpress.com by selecting “View Claims” to ensure you have received all services billed under your name.
- Protect your health insurance card like you would a credit card.
- Never provide health plan identification number to someone you don’t know.
- Any free medical services being offered at community fairs or other events should never require you to provide your health plan identification number.