A PRIVATE-PUBLIC PARTNERSHIP AGAINST HEALTH CARE FRAUD
Health care fraud is an intentional deception or misrepresentation that the individual or entity makes knowing that the misrepresentation could result in some unauthorized benefit to the individual, or the entity or to some other party.
The most common kind of fraud involves a false statement, misrepresentation or deliberate omission that is critical to the determination of benefits payable. Fraudulent activities are almost invariably criminal, although the specific nature or degree of the criminal acts may vary from state to state.
The variety of fraudulent reimbursement and billing practices in the health care area is potentially infinite. The most common fraudulent acts include, but are not limited to:
The United States spends over $2.27 trillion on health care every year. Of that amount, NHCAA estimates that tens of billions of dollars are lost to health care fraud. This loss directly impacts patients, taxpayers and government through higher health care costs, insurance premiums and taxes. Additionally, health care fraud often hurts patients who may be subjected to unnecessary or unsafe procedures or who may be the victims of identity theft.
Many states have created specific insurance fraud statutes. Some of these statutes apply to all lines of insurance. Others may apply only to workers compensation or health care. These statutes typically make it unlawful, among other things, for any person to present a false or misleading statement in support of a claim for payment pursuant to an insurance policy.
Offers of “free” medical treatments or consultations often sound appealing and legitimate. They may come in advertising, a telephone solicitation, even at your front door.
Be careful. Sometimes they are a lure used by scam artists to obtain your patient identification and insurance information to commit health insurance fraud. Over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges. We all pay in the form of higher health insurance premiums. Our medical histories can be permanently altered when diseases or injuries we’ve never had are falsely entered on our records to justify the illegal charges.
Offers of “free” services are often fraud schemes designed to bill you and your insurance company illegally for thousands of dollars of treatments you never received.
Protect your health insurance card like your credit card.In the wrong hands, a health insurance card is a license to steal. Don’t give policy numbers or other identifying information to door-to-door salesmen or telephone solicitors.
NHCAA offers membership categories for health insurers, governmental entities, and other companies and organizations that support the NHCAA Mission, as well as individuals, who want to join us in the fight against health care fraud.
National Health Care Anti-Fraud Association Headquarters
1220 L Street, NW, Suite 815 | Washington, DC 20005 | Phone: 202.659.5955 | Fax: 202.785.6764