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• SIU Red flags

SIU Red Flags

IF YOU SUSPECT FRAUD - CALL THE SIU HOTLINE - 1 888-4KO-FRAUD

BE SUSPICIOUS IF SOMEONE SAYS:

• "I represent EmblemHealth" without a valid reason for calling.
• "The service/equipment is free."
• "I need your EmblemHealth ID number," or your Social Security number.
• "I will pay you if you give me/let me use your EmblemHealth number."
• "I will pay you to visit my office."
• "I know how to get EmblemHealth to pay for it."
• "EmblemHealth wants you to have this."
• "The more tests we provide the cheaper they are."

ALSO BE SUSPICIOUS IF SOMEONE:

• Routinely waives co-payments without checking on your ability to pay.
• Advertises "free" consultations.
• Shows up at the front door or calls on the phone to market EmblemHealth related services or products.
• Bills EmblemHealth for services you don't recall receiving.

UNLAWFUL ACTIVITIES INCLUDE:

• Billing more than once for the same service or product.
• Misrepresenting the services rendered.
• Misrepresenting a diagnosis to justify payment for services.
• Misrepresenting the place of service.
• Altering EmblemHealth claim forms to get a higher payment.
• Falsifying documents.
• Soliciting, offering or receiving a kickback, bribe or rebate.
• Secretly agreeing to any arrangement among parties that will result in higher charges to EmblemHealth.