HOW TO RECOGNIZE HEALTH AND DENTAL BENEFITS FRAUD

Benefits fraud is not always easy to spot, especially when a trusted coworker, friend, family member or health or dental service provider suggests it. Look for these warning signs and alert your insurer if they occur:

  • Feeling pressured by your health or dental service provider to get unnecessary products or procedures
  • Being encouraged to claim products or services that are not eligible as a benefit under your plan as different products or services that are eligible
  • Health or dental service providers who seem more concerned with the details of your insurance coverage than providing the right product or service
  • Feeling encouraged to include incorrect or misleading information on a claim
  • Being asked to sign a blank claim form (often completed later with misleading information)
  • Health or dental service providers who use your plan membership information to charge for products and services you never received
  • Being offered cash or other incentives in exchange for your policy information
HOW TO USE YOUR BENEFITS APPROPRIATELY

Understanding your benefits and how to use them appropriately can help you recognize and guard against potential fraud. Here’s how:

  • Familiarize yourself with your benefits plan and the limits of your coverage
  • Keep your personal benefits plan access information in a safe place and don’t lend your card to anyone
  • Be sure you understand the treatments, services, and products being prescribed to you -- don’t be afraid to ask questions!
  • Check that the explanation of benefits (EOB) and receipts provided by your insurer contain accurate information about the services or products you received
  • If you notice anything suspicious, alert your insurer

HOW TO REPORT HEALTH OR DENTAL BENEFITS FRAUD

Benefits fraud affects everyone, and it’s our shared responsibility to report it when we see it. If you suspect that a coworker or health or dental service provider is committing benefits fraud, you can report it anonymously here.

Frequently Asked Questions

Who commits health and dental benefits fraud?
Benefits fraud can be committed by health or dental service providers, plan members or both.
How can you protect yourself from the consequences of health and dental benefits fraud?

Learning how to recognize benefits fraud is the first step toward preventing it. If you suspect your health or dental service provider or coworkers are encouraging you to submit a fraudulent claim, or something just doesn’t feel right, report it to your employer or insurance provider immediately. You can also report benefits fraud anonymously here: report benefits fraud.

What are some examples of health and dental benefits fraud?
  • Billing for services that never occurred
  • Health or dental service providers offering excessive cash incentives to attract new patients
  • Health or dental service providers falsifying medical conditions to provide an unnecessary treatment or service
  • Health or dental service providers and plan members conspiring to increase the amount of a claim to ensure full coverage so the plan member doesn’t have to pay the deductible
  • Claiming services different than those provided
  • Transferring unused benefits to others, such as using a dependent’s unused benefits to cover another’s health or dental expenses
     
How do you report health and dental benefits fraud?

You can report benefits fraud directly to your employer, or anonymously here

Can you report health and dental benefits fraud anonymously?

Yes. If you would like to report benefits fraud anonymously, you can do so here. 

How to report health or dental benefits fraud

Benefits fraud affects everyone, and it’s our shared responsibility to report it when we see it. If you suspect that a coworker or health or dental service provider is committing benefits fraud, you can report it anonymously here.