Health care fraud
What is health care fraud?
Health care fraud is a crime involving theft by deception. It occurs when a provider or consumer intentionally submits claims that misrepresent services performed or received. The National Health Care Anti-Fraud Association estimates that between 3–10 percent of what Americans spend annually on health care is lost to fraud and abuse.
What is HealthPartners doing to stop fraud?
HealthPartners’ Special Investigations Unit (SIU) works to prevent and stop fraud and abuse against HealthPartners and its members. The SIU works to detect and investigate potential fraud and abuse through various reports, complaints and potential irregular billing patterns.
HealthPartners’ policy is to protect itself, its members and the community against health care fraud and abuse. Our process includes prevention, detection, investigation and reporting, which may also include the recovery of money lost to fraud and abuse.
Examples of health care fraud
- Billing for services not actually performed
- Misrepresenting diagnoses/procedures performed to obtain payment for non-covered services such as cosmetic surgery
- Performing services that are not medically necessary for the purpose of receiving insurance payment
- Altering claims
- Inaccurate enrollment documentation such as covering a dependent as a full-time student when not enrolled
- Using another person’s insurance card
- Filing claims for services or medication not received
- Waiving patient copays or deductibles and over-billing the insurance carrier or benefit plan
You can help avoid and prevent health care fraud
Take steps to protect yourself from being a victim of health care fraud. See examples of health care fraud, and learn what you should do if you suspect fraud.
- Always review your Explanation of Benefits (EOB) statements for accurate charges and report any discrepancies
- Ask questions about the services you receive such as “Why are they needed?” or “What do they cost?” and “Are the services available at my primary provider or local facilities?”
Let us know if you suspect any of the above situations or if you have any questions. You can contact our fraud and abuse hotline directly by calling 952-883-5099 or 1-855-332-7194. You can also call our Member Services number (located on the back of your insurance card) and then ask to be transferred to the fraud and abuse hotline. You may remain anonymous.
You may also mail or fax us at:
HealthPartners Special Investigations Unit
Mail route 25110F
P.O. Box 1289
Minneapolis, MN 55440-1289