Healthcare Fraud

Healthcare fraud is commited when someone intentionally submits false or misleading information to obtain payment for healthcare services.

Examples of Healthcare Fraud

• A healthcare provider or member submitting a claim for an item or service more expensive then the item or service provided.
   
• A healthcare provider or member submitting a claim for services not rendered, or not necessary, or provided to a person other than the covered member.
   
• One individual using another individual's insurance coverage information to receive services. (One person posing as another person.)
   
• A health plan member enrolling an individual who is ineligible for coverage under the plan.