What you need to know about health care fraud
Health care fraud is not a victimless crime. It affects everyone, both individuals and businesses, and causes tens of billions of dollars in losses each year. It can also raise health insurance premiums and cause you unnecessary costs. Here’s what to know about this type of fraud and how to protect yourself.
What is health care fraud?
Health care fraud can be committed by medical providers, patients and others who intentionally deceive the health care system to receive unlawful benefits or payments. This type of fraud often goes undetected, similar to medical equipment scams, because there is typically no direct out-of-pocket cost to the member. In addition, items or services can easily be missed in an Explanation of Benefits (EOB) statement.
How does this type of fraud happen?
Health care fraud can occur if your information gets into the wrong hands and is then used to bill fake claims without your authorization or knowledge. This could include your Medicare beneficiary number, secondary insurance member ID number and social security number, among other information.
Sharing your personal information or member identification number generally means giving your information to someone other than your doctor, clinic, hospital or a health care professional. To protect your medical member ID number, only share your member or beneficiary card or number with a trusted provider who is providing you with services.
Examples of schemes used to obtain member information
Fraudulent vendors or providers may use a variety of tactics or schemes to get your information, including:
- Stealing or purchasing your Medicare or insurance identification information.
- Offering you free gifts or services in exchange for your personal insurance information through phone calls, emails or letters.
- Using phrases like “you are entitled to these free benefits” or “you will not have any out-of-pocket costs.”
- Phishing calls or contacting you several times using different methods, such as offering to send you a free laminated Medicare card if you share your member identification number.
- Sending you medical equipment without your knowledge and then asking you to provide your insurance information once you have the equipment.
Avoiding suspected fraud
The North Dakota Retirement System has seen an increase in members becoming victims of these types of health care fraud schemes. It’s important to be cautious of people who say they want to help you before asking for your medical information, including:
- Door-to-door and telephone salespeople or emails requesting your card number
- Unknown medical companies or business offering you services
- Strangers who offer you free medical tests, exams or other gifts in exchange for your card number
How to protect yourself
- Do not provide your medical insurance information to anyone except your physician’s office and pharmacy.
- Never accept medical equipment or services that you are told are free in exchange for your Medicare number.
- Don’t trust TV ads promoting free items or mailing inserts promoting free offers.
- Review your Explanation of Benefits (EOB) paperwork regularly to look for items that you didn’t order or receive and report any discrepancies immediately.
If you suspect that your member information has been compromised or that you may have been a
victim of a health care fraud scheme, contact any of the following resources.
Sanford Health Plan
(877) 473-0911 (TTY:711)