Health Insurance Fraud ~ Detection & Prevention Tips

You, as a health insurance participant, are the most important link in finding insurance fraud. You know better than anyone what health care services you have received. Review your Educators Explanation of Benefits when you receive it, and make sure you understand all of the services listed.

If you don’t remember a procedure listed, you should contact the provider of the services. Many times small mistakes can be corrected by simply calling the provider.

If you are unable to have your questions answered and you still suspect insurance fraud, you should contact Educators Mutual at 262-7475 and select option #1.

Examples of fraud ~

~ Billing EMIA for services or items that you did not receive

~ Receiving services for ineligible dependents

~ Billing of non-covered services under a different type of service for payment

Detection Tips ~

You should be suspicious if the provider tells you

~ “There’s no charge. I only need your insurance ID number for my records.”

~ “Your insurance company wants you to have this procedure done twice.”

~ “Don’t worry about the charge. We know how to get your insurance to pay for it.”

Prevention Tips ~

~ Don’t ever give out your Social Security Number to anyone except your physician.

~ Don’t request tests or services that you don’t really need.

It is in your best interest, and that of others, to report suspected fraud. Health care fraud increases premiums for insureds. We must work together in order to reduce health care costs.