Protect your patients and your practice.
Healthcare providers play a vital role in helping patients use their health and dental benefits to access critical healthcare services and supplies. Benefits fraud puts that access in jeopardy. Your patients could lose their benefits due to the financial burden on their employer (among other serious consequences). If you knowingly participate in fraudulent activities as a healthcare provider, you could lose your reputation, your income and your license.
You can help protect your patients and yourself from becoming involved in benefits fraud by being clear about the services and supplies you provide, providing accurate and complete invoices and receipts, following correct claim submission procedures, and directing patients to their employer or insurance carrier if they have questions about their coverage. Take the quiz below to see if you’re on the right track.
Test your knowledge about group benefits plans.
Are you familiar with correct invoicing and claim submission procedures? Do you know what benefits fraud looks like? Take this quiz to find out.
To learn more, see the FAQs below.
Frequently Asked Questions
What are the consequences of health and dental benefits fraud?
Health and dental benefits fraud is a crime with serious consequences that can result in loss of employment, a criminal record, and even jail time for you or your patients. As a healthcare provider, you could also lose your reputation, patient trust, your source of income and your license.
What is delisting and how does it happen?
Delisting means that the services and supplies you provide will no longer be eligible for reimbursement under the delisting carrier’s benefits plans. For example, if an insurer finds that you have not been following correct claim submission procedures they may decide to delist you.
How do I ensure continued reimbursement of my patients’ claims?
Some ways healthcare providers can maintain good standing include following the claim submission procedures outlined by the insurer and completing claim forms clearly and accurately. You should also keep detailed records of the services and supplies you provide so that you can verify that you have followed correct procedures when asked.
How do I know I am submitting a claim correctly?
To submit a claim correctly, whether on paper or electronically, follow the insurer’s claim submission procedures and ensure that the invoice and receipt accurately reflect the services or supplies provided. Do not leave any fields blank; enter ‘0’ or ‘NA’ if needed. A receipt should not be issued until the patient has received and paid for the service or supply. Learn more about receipt best practices.
Am I allowed to offer patients discounts as an incentive or to help ease their financial burden?
You may offer your patient a discount on your services or products, but the discount must be applied and clearly stated on the invoice or receipt submitted with the insurance claim. The invoice should state the total amount, including the discount.