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 and abuse 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. When marketing your services, you can protect your patients and yourself from benefits abuse by eliminating any “use it or lose it” messaging.
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.
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Only healthcare providers suspected of fraud and abuse will be audited.
As a service to patients, it’s okay to ask or allow them to sign a blank insurance claim form to be completed and submitted later, or to ask a patient to sign a claim form in advance of receiving products or services.
If my patient wants to be fully reimbursed but their plan only covers 80%, it is okay to claim a higher amount to make up the difference.
If a patient has already reached the coverage limit for a treatment but they need more, I can submit a claim in a different treatment category, or under the name of another family member covered by their plan so they can still be reimbursed through their coverage.
Submitting false or misleading insurance claims only impacts insurers.
It’s okay to offer patients incentives with their insurance claim.
If my patient has group benefits their claims will always be paid.
All benefits plans offer the same coverage.
Frequently Asked Questions
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.
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.
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.
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.
You may offer your patient a discount on your services or products (where permitted by regulation), 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.