| The cost of
fraud not only results in losses for insurance companies, but it
also affects you, the policyholder and Medicare beneficiary. When
undetected fraud occurs it results in Federal cuts in Medicare,
higher deductibles, premiums and taxes that are passed on to you. |
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| What
Can You Do? |
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Everyone
should review all correspondence received from their insurance
companies and health care providers. The following is one of the
most common fraud schemes: |
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A provider submits
for payment a fraudulent bill using your policy. The bill may
include services or tests that were not performed or services
that were previously paid. You, the policyholder, may be the best
person to detect this type of fraud by simply reading the statement
from our Company and comparing the information to the bill you
received from your provider. |
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Other common fraud
schemes may involve the following: |
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Providers
that bill insurance companies for services that were not
medically necessary. |
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Provider
submits a bill that was "Upcoded"--where the provider
bills the Company for a higher service or product than actually
provided |
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Providers
offering to waive coinsurance amounts for services. In many of these
cases, the provider increases the amount charged to make up for the
waived coinsurance amount. |
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| Our
Responsibility |
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Our company is
committed to cooperating with Local, State and Federal Law
Enforcement entities so that more insurance fraud can be identified.
In addition, we
will promptly review fraud that is reported to us. If you become
aware of fraudulent activity related to any of our policies, contact
us by e-mail
or by calling (972) 529-5085.
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