Fraud & Abuse
UHCP wants to make sure your health care dollars are used as intended. Fraud and abuse can negatively affect the quality of health care services you recieve, and increase the cost of heatlh care for all members. The National Helath Care Anti-Fraud Association estimates that 3-10% of all health care payments are lost to fraud and abuse.
Fraud is an intentional deception or misrepresentation made by a person with the knowledge that the deception could results in some unauthorized benefit.
Abuse is any practice that is inconsistent with standard business or medical practices, which results in unnecessary costs to the health plan.
Fraud and abuse can come in many forms - from loaning an insurance identification card to someone to obtain medical servcies to complex billing schemes by providers.
What can I do to prevent fraud and abuse?
- Always review your UHCP Explanation of Benefits (EOB) to confirm that the services billed were the services you received.
- Never give your insurance identification card or number to anyone who isn't your health care provider.
What can I do if I supect fraud and abuse?
If you suspect fraud and abuse, you may report it by completing the fraud and abuse form at the top or by contacting UHCP's Compliance Officer at 888-271-5870, option 1. All reports will remain confidential, and you may remain anonymous.