How to Report Health Insurance Fraud

Health insurance fraud occurs when a person submits or leads another person to submit fake or incorrect information to increase the amount of benefits paid. Furthermore, health insurance fraud can be through the sale of nonexistent health policies or by bogus medical tests to increase claims. This type of fraud results in millions of unpaid medical bills per year. There are several ways to easily report it.

Difficulty: Moderately Challenging

Instructions

Things You'll Need:

• Phone
• Computer with Internet access

Report Health Insurance Fraud Right Away

1. Contact the company you have health insurance through to file a report. Most insurance companies provide report filing forms on their Web sites.

2. Provide an explanation of the type of health insurance fraud that has occurred. This could be payment for services that were not performed, suspicion of someone using an expired card or ordering unnecessary tests.

3. Call the number listed on your health insurance identification card if you suspect that someone is wrongfully submitting claims under your insurance policy.

4. Save all medical claims such as bills, results of tests, records of prescriptions and statements. You will need these for evidence in your report.

5. Locate your state insurance regulator's office. You can find state-specific links at the Consumer Action Web site (see Resources below). Each state has its own regulations for enforcing health insurance fraud. This will help you streamline your report.

6. Report your health insurance fraud claim to the Office of the Inspector General for Medicare fraud. (Medicare is the United States government insurance.) The official will evaluate your claim to see if it falls under the proper jurisdiction.

Protect Yourself from Health Insurance Fraud

7. Guard your personal information. Do not blindly give out information to people taking surveys or those who come to your door or call you. Make sure you are speaking with an official healthcare provider.

8. Be aware of prescription drug scams. Visit the Better Business Bureau to get tips and resources about current health insurance activity affecting consumers (see Resources below).

Tips & Warnings

• Lending an ID card to someone not entitled to use it is considered health insurance fraud. If your card is lost or stolen, report it immediately to your insurance provider.
• Consult an insurance fraud attorney if the claim is on a large scale with a corporation.
• If an insurance company claims it does not have to be licensed or is exempt from state regulation, do not do business with that company. Check with your state insurance department to see if they have a license.

[monicap]

on 3/23/2009 There is a case manager in the ER that requests that the nursing staff make specific documentation on charts to qualify the patient for a "full admission" or allows the patient to be placed in a higher category. She never directly tells anyone to lie, instead she says things like,"I would like this patient to be a full admit so I need your documentation to show ....", or "I need this to say....", or "can you document this...". It makes me feel uncomfortable and I have questioned her about this before. I finally told her that I would not lie on my charts anymore. That's when our director called me into the office and "recommended" that I didn't make any comments like that anymore. However, the behavior continues and now has included the doctors "adjusting" their documentation. I think this is fraudulent and should be reported. How do I go about dong this and how do I prove it?

[jenns413]

on 3/19/2009 how do you report someone that you know is participating in insurance fraud?

[boohoo]

on 3/17/2008 how do you report someone that you know is doing insurance fraud??? anonymously???
thanks

[happykat]

on 9/17/2007 If you want to report information anonymously to a company or agency, you can use a postal remail service like texasremail.com. They will mail your correspondence for you from a Texas post office and your location and identity can remain anonymous.