Other Faqs

TO REPORT FRAUD

 National Health Care Anti-Fraud Association
1255 23rd Street, NW Washington, DC 20037 202.659.5955

http://www.nhcaa.org/


Health Care Financing Administration
 7500 Security Boulevard, Baltimore MD 21244-1850 Phone: 410-786-3000
http://cms.hhs.gov/


National Fraud Information Center PO Box 65868 Washington, DC 20035
1-800-876-7060
http://www.fraud.org/

Health & Medical Insurance Quotes Pro:

Faqs about fraud, fraud abuse and terms.

Fraud by a physician, specialist or hospital:

Waiving a patient's co-pay or deductible while billing the insurance carrier more than true-cost amount.

Billing for services not actually performed.

Falsely justifying procedures that are not medically necessary.

Changing codes of a procedure in order to receive payment for services that are not covered.

Billing the next higher procedure in order to receive more money.

Instead of billing for one procedure, they may break it up into many billing cycles in order to up the procedure cost.

Billing a patient more than the co-pay amount for services that were prepaid or paid in full by the insurance plan.



What is the difference between fraud and abuse?

Fraud is an intentional deception that someone makes, that could result in an unauthorized insurance payment. Whether it is successful or not, it is still fraud. Abuse involves actions that are inconsistent with accepted normal practices. Abuse directly or indirectly results in unnecessary costs to the insurance program through improper payments. The real difference between fraud and abuse is the person's intent.

No matter who commits a fraudulent claim, it costs us all in higher premiums and overall costs of our health insurance plans. So if you believe there has been a fraudulent action, report it immediately to one of the agencies list at left.


Medical necessity -
This is a term used to refer to a course of treatment seen as the most helpful for your health issue. The course of treatment is deemed necessary by your physician, specialist or hospital. This course of treatment strives to provide you with the best care in the most appropriate setting.


What is COBRA?
The letters C O B R A stand for Consolidated Omnibus Budget Reconciliation Act of 1985. COBRA is a federal law that allows an individual to continue paying for health coverage if they lose their job. Check with your Human Resources Department to see if your employer is subject to this law, and if you are eligible for COBRA coverage.


What is a Primary Care Physician?
A Primary Care Physician is trained to manage your entire health care program. Your Primary Care Physician plays many roles - primary caregiver, health care advisor and consultant, coordinator of specialty care and patient advocate

Primary Care Physicians can include:

  • Family/General Practitioners (Doctors who treat patients of all ages)
  • Internists (Doctors who treat adults and may have a subspecialty)
  • Pediatricians (Doctors who treat children)
  • Gynecologist (Doctors who treat women)


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