How to recognize benefits fraud
Release Date: 10/23/2018 Staff Reference: Shannon DeLenardo | | |
 | Watch out for providers who try to use your plan member information (i.e., usernames, passwords and other personal information) to charge for products and services you never received. | |
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 | Your explanation of benefits contains products or services not obtained by you or your eligible dependents. Always review your explanation of benefits and report any discrepancies to your employer. | |
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 | Your provider requests (supposedly for your convenience) that you sign a blank claim form. By having a signed healthcare or dental claim form, it is much easier to commit fraud in your name. | |
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 | Claiming for products and services not eligible as a benefit under your plan using benefit codes that are eligible for reimbursement (e.g., a spa day treatment submitted as massage therapy, designer sunglasses submitted as prescription glasses). | |
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 | You are offered cash or other incentives in exchange for your policy and certificate numbers. Report anyone asking for this type of information. | |
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 | Be on guard if your health care provider appears more concerned about obtaining a list of your covered benefits and the associated plan maximums than they are about providing you with the right product or service. | |
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 | With offers of incentives remember the “too good to be true” rule. Somebody is paying for those free services perhaps through hidden fees or built-in costs. | |
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 | Beware of providers that offer to bill a service as something other than the service received as a way to work around eligibility requirements or plan maximums. | |
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 | Shop around and ask questions to ensure the health care provider has the appropriate credentials for the services you are receiving. | |
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 | When paying for products/services, be wary of providers who ask if you have insurance. You or your plan sponsor may end up paying more than someone who does not have insurance. | |
