Help Stop Health Insurance Fraud

What can you do

  • Help prevent Health Insurance Fraud and Abuse!
  • Ask questions about the services you receive, such as: Why are they needed? What do they cost? Will my insurance cover it?
  • Question advertisements or promotions that offer free tests, treatment or services – especially when the provider requests your insurance information or a copy of your insurance ID card.
  • Be careful about disclosing your insurance information. Protect your insurance ID card as if it were a credit card. It represents your benefits.
  • Question charges you’re asked to pay by a provider that exceed the copayment amount you are required to pay.
  • Be leery of health care providers who offer free services or waive your copay. They may charge the insurance company more for other services to make up the difference, or add services you didn’t receive.
  • Review your Explanation of Benefits (EOB) and/or your medical bills. Are the dates of service correct? Were the services actually performed? Were you billed for the same procedure twice?
    • The medical codes reflected on your EOB are easily researched online. Current Procedural Terminology (CPT) Codes, and Healthcare Common Procedure Coding System (HCPCS) Codes identify the procedure rendered and determine the reimbursement a healthcare provider should receive for the service
  • Keep accurate records of all health care appointments.
  • Research your providers with Medical Board of California.
  • Report suspected fraud and abuse as soon as possible.