Detection Tips
Be suspicious if the provider tells you that:
- They know how to get your health plan to pay for an item or service.
- The more tests they provide, the cheaper they are.
Be suspicious of providers who:
- Do not charge copayments or coinsurance without first checking on your ability to pay.
- Advertise free consultations to people with health coverage.
- Use pressure or scare tactics to sell you high-priced medical services or diagnostic tests.
- Bill your health plan for services or items you did not get.
- Bill your health plan for services or equipment that are different from what you received.
- Use telemarketing and door-to-door selling as marketing tools.
- Use another person's health plan ID card to get medical care, supplies, or equipment for you.
- Put the wrong diagnosis on the claim so your health plan will pay.
- Ask you to contact your doctor and ask for a service or supplies that you do not need.
- Offer you payment or gifts to go to clinics or offices.
Prevention Tips
To help protect yourself and your health plan, you should report all suspected instances of fraud and identity theft.
The following is a list of tips to prevent fraud:
- Never give your health plan ID number to anyone, except your doctor
- Don’t allow anyone, except your medical providers, to review your medical records or recommended services.
- Don’t contact your doctor to request a service that you do not need.
- Don’t ask your doctor to make false entries on prescriptions, bills, or records in order to get them paid.
- Don’t accept medical supplies from a door-to-door salesman.
- Do be careful in accepting Medical services that are represented as being free.
- Do be cautious when you are offered free testing or screening in exchange for your health plan number.
Do avoid a provider of healthcare items or services who tells you that the item or service is not usually covered, but they know how
to bill your health plan to get it paid.
