Health Care Fraud: Can We Cut the $80 billion Tab?

Health care fraud is a major problem that not many people talk about or hear about. The fact is, it costs us $80 billion a year. That’s about $250 for every man, woman and child in United States. In order to reduce that number, it’s important to understand what health care fraud is, and what can be done about it.

What is health care fraud?

Health care fraud is the falsification of health care transactions. It can be done by a doctor, a business or a member of a health plan.

What are examples of health care fraud?

There are many types of fraud related to health care. Here are some of them:

  • Billing for health care services that did not happen
  • Health care services done simply to get reimbursement
  • Billing for health care services or drugs not received
  • Forging or altering bills, receipts or other health care forms
  • Going from doctor to doctor to get multiple prescriptions
  • Knowingly letting someone who is not on your contract or policy use your health care coverage (for example, allowing a friend to use your HAP card to obtain health care services)

What are the penalties?

Health care fraud is a felony under Michigan's Health Care False Claims Act. Anyone convicted of this crime may face time in prison and major fines. In fact, someone could face up to four years in prison, a $50,000 fine and loss of health insurance. It's also a federal criminal offense under the Health Insurance Portability and Accountability Act, known as HIPAA. 

What are we doing to stop health care fraud?

HAP uses special software that monitors claims data and other information that identifies claims. We also employ a team of highly skilled professionals who are dedicated to looking for and identifying instances of health care fraud. These measures are designed to protect our members.

What can you do if you suspect health care fraud?

If you see or hear about something you feel may be health care fraud, please contact us right away. We look into every reported incident. There are a few ways to report health care fraud to us:

0891 Mail Phone2Call HAP's compliance hotline 24 hours a day at (877) 746-2501. 

0891 Mail Phone You can report possible fraud to HAP in writing.

Be sure to include your contact number, date of service and other information you think may be useful. Send your report to:

HAP Compliance department

2850 West Grand Blvd.

Detroit, MI 48202

 

Below are other ways to report health care fraud:

 

0891 Member Exclusive TypeStealing medical information is also a form of identity theft, and it can lead to health care fraud. HAP members have identity theft protection from Assist America built into their health plans.

 

See related post: Protect Yourself from Identity Theft

Categories: Get To Know Your Plan

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