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Fraud and Abuse

Fraud is everyone’s business

Health care fraud affects all of us —from small businesses to corporations, insurers, doctors and members. It impacts the quality of health care and results in higher costs.

What can you do?

Know what to look for. Be suspicious if providers of medical or dental services or supplies:


  • Bill significantly more than other doctors for treatment you’ve had in the past
  • Offer treatment while promising you won’t have to pay the balance due after insurance pays
  • Offer to bill your insurance for services that weren’t performed in order to cover your out-of-pocket costs
  • Bill for treatment you haven’t received yet
  • Bill insurance when you used a coupon for “free services”
  • Bill insurance for services or equipment you did not get, want or request
  • Order what appear to be more tests than are necessary
  • Want you to bring other family members with you to your appointments to treat them for the same condition, even if they don’t have the same medical complaints as you
  • Ask you to fill a prescription and bring the medicines back to their office
  • Call to offer you “free” medical equipment your doctor didn’t order
  • Call to offer getting certification for medical equipment neither you nor your doctor previously discussed using

Also, be suspicious if you get shipments of medication, creams or other supplies you didn’t order nor do you want.



We’re here to help!

Suspect fraudulent activity?

Call our hotline at 1-800-338-6361 (TTY: 711) or email us at

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We have free interpreter services to answer questions you may have about our health or drug plan.

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