Tips for avoiding health care fraud or health insurance fraud

SAN DIEGO (KUSI) – A press conference held Monday addressed what the public can to protect themselves against health care fraud. 

Below is information from the FBI

  • Never sign blank insurance claim forms.
  • Never give blanket authorization to a medical provider to bill for services rendered.
  • Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.
  • Carefully review your insurer’s explanation of the benefits statement. Call your insurer and provider if you have questions.
  • Do not do business with door-to-door or telephone salespeople who tell you that services of medical equipment are free.
  • Give your insurance/Medicare identification only to those who have provided you with medical services.
  • Keep accurate records of all health care appointments.
  • Know if your physician ordered equipment for you.
  • Protect yourself

Here are several tips on protecting your information-and yourself-from unscrupulous heath care fraudsters:

  • Safeguard insurance cards and benefit information. Make sure there’s a legitimate reason to provide your insurance card or insurance information to others, and be especially vigilant if your information is requested when services are offered for free, or any offers are made during telemarketing calls.
  • Be aware of gifts, or other inducements, from visiting medical providers. Don’t accept unnecessary equipment or products, and report any suspicious or unusual activity.
  • Be careful when receiving medical supplies that you actually get what was ordered-for example, instead of a power wheelchair, you receive a much cheaper scooter instead.   
  • Be aware of your surroundings in medical facilities. For example, be wary of if you completing a physician visit at a medical office that lacks normal medical equipment and its personnel don’t conduct normal patient health checks like taking your temperature and blood pressure.
  • How criminals steal your information
  •  Beneficiaries should always be aware of potential fraudulent activities when dealing with medical providers via the Internet and during their normal daily activities. It’s important to know who you’re dealing with and why since many health care fraud scams involve the theft of patients’ medical information which is then used in schemes to obtain reimbursement for services and goods not provided.

Here are some of the most common methods used by criminals to fraudulently obtain patient insurance information:

  • Providing an inducement, such as money or a gift, to beneficiaries to visit a location (normally medical clinics) where identities are obtained when the patient signs in.
  • Obtaining patient information when patients obtain a free screening, a method frequently seen at health fairs.
  • Inducing medical personnel with access to patient insurance information to copy the information and provide it to those involved in fraud schemes.
  • Purchasing the information from others involved in fraud, including owners of fraudulent companies and marketers of stolen patient and physician billing information.
  • One of the most effective ways to determine if insurance information is being used without the knowledge of the insured is to review the explanation of benefits forms sent from their insurance company. These forms list the services and supplies supposedly provided to the patient from medical providers. If any billings are suspect, immediately contact the insurance company.   

If consumers suspect fraud, contact your health insurance company (most have toll free numbers to report fraud).

Medicare fraud can be reported to 1-800-HHS-TIPS (1-800-447-8477).

You can also contact your local FBI or HHS-OIG offices or your state’s Medicaid fraud office. The telephone number for the local FBI office is (858) 320-1800. 

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