Health Care Fraud-EmblemHealth Special Investigation Unit (SIU)
Insurance fraud is an often-committed crime in the United States. The federal government estimates that as much as ten percent of the dollars spent on health care may involve fraud and abuse. Why is the problem so vast?
There is a perception held by many that insurance fraud has no victim. Insurance companies have huge amounts of money, generate enormous profits and don't care about "trivial" fraud and abuse cases. Nothing could be further from the truth!
Who pays for losses due to fraud and abuse? We all do! Insurance companies
raise premiums to cover the cost of fraud. Employers pay lower salaries
due to the increased cost of health benefits. Taxes are higher to offset
the losses in public sector health insurance programs such as Medicare
Most providers and insureds are honest. However, all of us need to join
the fight to eliminate fraud and abuse in the healthcare industry committed
by those who are not. You may wonder what YOU, THE PUBLIC can do.
Here are some tips:
1. No fraud is too small. Never suggest or agree with a provider who
wants to waive a deductible or increase a fee to the insurance company.
For example, increasing a charge for a doctor's visit by $50 seems
small, but if one thousand people do it, the cost is markedly higher.
That number grows geometrically when you realize that millions of Americans
have some form of health coverage.
2. Your insurance ID card and those of your dependents are intended only
for your use. If you lend them to someone else, you are committing fraud.
Furthermore, you may create a health record for yourself which may cause
you problems in the future.
3. Read your Explanation of Benefits forms If you are not sure
about what your insurer was charged for, be sure to call and ask.
4. Treat a claim form like a credit card voucher. Never sign one that
is blank and let charges be filled in at a later time.
5. Be cautious if anyone tries to sell you drugs, medical supplies or
equipment. Check with your insurer first.
6. Ask questions of health care providers. If you are not sure about a
procedure or diagnosis, it is best to start with them. However, you should
always feel comfortable in calling your insurer at any time in the process.
Providers should do the same if they have any doubts about the person
presenting himself for treatment.
EmblemHealth's Corporate Special Investigations Unit is here to help the public
identify and eliminate fraud and abuse from the system. EmblemHealth will not tolerate
fraud. Feel free to call our toll-free anti-fraud hotline at any time.
The 24-hour number is:
EmblemHealth thanks you for your interest and your help!