Programs for Change. Committed to serving our neighbors and community.

Examples of Fraud

Fraud can be committed by, and affect, stakeholders across every area of the health care system. Health care fraud is a serious crime that affects everyones health care and is a costly reality that we cannot afford to overlook. Health care fraud is a federal criminal offense punishable by up to 20 years in federal prison.

Most Common Types of Fraud

  • billing for services not provided
  • billing for more expensive services than were actually preformed, commonly known as upcoding
  • performing medically unnecessary services solely for the purpose of reimbursement
  • billing non-covered services (e.g., cosmetic) as other covered services
  • prescription fraud and pharmaceutical diversion to include Medicare Part D
  • providing false information during enrollment
  • accepting bribes or kickbacks for patient referrals
  • routinely waiving co-payments and/or deductibles
  • medical identity theft

Things to Look Out For

  • Review your claims at amerihealthexpress.com by selecting View Claims to ensure you have received all services billed under your name.
  • Protect your health insurance card like you would a credit card.
  • Never provide health plan identification number to someone you dont know.
  • Any free medical services being offered at community fairs or other events should never require you to provide your health plan identification number.