Health care fraud is not a victimless crime.
It increases health care costs for everyone and it can be more dangerous than identity theft, as it can result in injury and even death. Health care fraud is punishable by jail and in some cases, life in prison.
What is health care fraud?
- Altered or fake medical claims and other documents.
- Excessive or unnecessary treatments.
- Billing schemes, such as:
- Charging for a service that is more expensive than the one provided, known as upcoding.
- Charging for services that were not provided.
- Billing for the same thing twice.
- False or exaggerated medical disability.
- Collecting on multiple insurance carrier policies for the same illness or injury.
- Adding or keeping someone on your coverage when you shouldn’t.
Why should you care?
According to the National Health Care Fraud Association, health care fraud costs consumers $100 to $300 billion a year, which is three to 10 percent of the nearly $3 trillion spent annually on health care in the country. Not reporting fraud contributes to the rising cost of health care for everyone.
Health care fraud exposes consumers to real, physical risk. People have been injured and have even died due to unnecessary surgery as part of fraud schemes.
How can you protect yourself?
- Treat your health insurance ID card with the same care you would a credit card.
- Beware of “free” services; although the patient might not be charged, the provider can bill your health insurance carrier.
- Review your medical bills and explanation of benefits after receiving health care services. Check that the dates and services are correct to ensure you got what you paid for. If there is a service listed that you didn’t receive, or if the name of someone who is not on your health care coverage is listed as the patient, that could indicate fraud.
- If you suspect someone of committing health care fraud, report it.
- Download the Blue Cross Blue Shield of Michigan app so you can easily access information no matter where you are.
If you’re a Blue Cross Blue Shield of Michigan or Blue Care Network member and you suspect health care fraud, call our confidential, toll-free anti-fraud hotline at 1-800-482-3787.
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Photo credit: Skeyndor