Last year, the FBI estimated that between 3% and 10% of all health care spending in the U.S. went towards fraudulent claims. Fraud has real effects on everyone in the health care system. For members, fraud increases the costs of benefits and reduces the quality of care they receive. For employers, fraud increases the cost of providing benefits and the overall cost of doing business. Fraud can often result in unsafe medical procedures and false medical records which can lead to devastating effects.
AmeriHealth’s Corporate and Financial Investigations Department (CFID) continues to add value to our fight against health insurance fraud, waste, and abuse (FWA). CFID detects and investigates potential areas of FWA with the help of confidential information received from many stakeholders, including providers, members, employees, and members of the general public. In 2013 alone, CFID recovered $2.99 million in fraudulent, abusive, or wasteful claims paid. In the last five years, over $8.73 million has been recovered by CFID in fraudulent, abusive, or wasteful claims.
How You Can Help
CFID owes much of its success to the members, providers, and other stakeholders who have been instrumental in reporting fraudulent activities. If you suspect health care fraud against Independence and/or you, we urge you to report it. All reports are confidential. You are not required to provide your name, address, or other identifying information.