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Policy Statement

Physicians Health Plan (PHP) is committed to the prevention of healthcare fraud. Fraud or abuse of healthcare benefit payment results in higher healthcare costs and higher insurance premiums for everyone. Healthcare fraud is a crime. It is the policy of PHP to monitor for evidence of fraud and to investigate allegations of fraud or abuse of healthcare benefit coverage.

Examples of Healthcare Fraud

Healthcare fraud is committed when someone intentionally submits false or misleading information to obtain payment for healthcare services. Examples include:

  • 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. 

Preventing Healthcare Fraud 

How You Can Avoid, Identify, and Prevent Healthcare Fraud

  • Ask questions about the services you receive.
  • Fill out, sign, and date one claim form at a time; never sign a blank form.
  • Question advertisements or promotions by providers that offer free tests, treatment or services, especially if you are required to provide insurance information.
  • In general, be careful about disclosing your insurance information. Protect your identification card. It represents your benefits.
  • Examine your medical bills and compare your bills to your records and your PHP Explanation of Benefits (EOB).
  • Report suspected fraud to a PHP representative. 

Reporting Possible Healthcare Fraud 

Each of us can help control healthcare costs by being alert for signs of possible fraud. Please notify PHP if you suspect that your information has been utilized in an attempt to fraudulently obtain payment or services.

  • You may contact your customer service representative at (260) 432-6690, ext. 11; (800) 982-6257, ext. 11; or (260) 459-2600 for the hearing impaired.
  • You may contact your customer service representative via the PHP Web site at www.phpni.com, or by email at custsvc@phpni.com.
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