What is health care fraud? It's when a medical provider or plan member submits, or causes someone else to submit, false or misleading facts to determine the amount of health care benefits to be paid. And it’s a crime!
Common types of fraud include:
- Medical identity theft;
- Giving false statements on an application;
- Submitting claims for services that were not performed;
- Misrepresenting services that were provided; and
- Providing medically unnecessary services.
Insurance fraud is a serious crime! Read your Explanation of Benefits (EOB) carefully. The EOB is your notice that QualChoice has paid a claim under your health care plan. Look for:
- Incorrect dates of service;
- Services that you did not receive;
- Services from ancillary providers (labs, x-ray providers, etc.) that did not see or treat you.
If you suspect fraud:
Call: 800.235.7111, ext. 6740, or
Write: P.O. Box 25610, Little Rock, AR 72221
All reports are private.