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Fraud Costs Top $85 Billion a Year
Report Suspected Fraud: 1-800-336-4522 (or 410-998-5480)
Health insurance fraud has many forms, but collectively it is costing upwards of $85 billion a year, according to the US General Accounting Office. The most common types of fraud include:
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Billing for services that were offered for "free" |
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Billing for services that weren't provided |
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"Upcoding" - charging for a more complex or expensive service than was actually provided |
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Billing for a covered service when the service actually provided wasn't covered |
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Billing for services provided to their own family members |
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Using a member ID card that doesn't belong to them |
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Not removing someone from their policy when they're no longer eligible (for example, former spouses or children who are no longer dependents) |
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Adding someone to their policy that isn't eligible (for example, grandchildren or overage dependents) |
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Doctor shopping - visiting several doctors to obtain multiple prescriptions (often for controlled substances) |
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As CareFirst members and providers, please help us fight fraud by letting us know when you encounter the following:
- An Explanation of Benefits (EOB) showing services that you did not receive or that shows providers or dates of service that are not correct
- Someone using a member ID card that is not theirs
- A member adding someone to his or her policy that is not eligible or not removing former spouses or children who are no longer dependent from a policy
- Billing for services that were not provided
- Billing for services that are more complex that the service that was performed
Preventing Fraud
You can help prevent fraud by keeping your member ID in a safe place. If your ID is stolen, report it immediately.
Reporting Fraud
You can report suspected fraud using this online form.
You can also contact our fraud hotline at 410-998-5480 or toll-free at 1-800-336-4522. Phone calls can remain anonymous.
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