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1.877.627.0004
Fraud Waste & Abuse
(Please choose your category)
Altered Information on Documents
Forged information on applications; forged information on prescription scripts; theft of prescription scripts.
Claim and Billing Discrepancies by Providers
Medical equipment companies (durable medical equipment –DME-); provider wrongful billing; providers billing services that were provided by other provider; providers charge the insured for services covered by the plan and/or for Non applicable copayments.
Explanation of Benefit Discrepancies
Services provided, or provider does not match EOB - An insured received medical services and when he/she receives the explanation of benefits realizes that our plan made payments on services that the insured did not receive. Also, when the explanation of benefits mentioned a provider that the insured did not receive any services from. For example, the insured receive X-ray services, but the explanation of benefits states an MRI.
Required Medical Information Omissions
Omission relevant medical information; omission relevant medical information by agents.
Unauthorized use of Health Plan Card
Card stolen or lost; insured provides medical card to be used by another individual.OtherOther Fraud Waste & Abuse issues.
Other
Other Fraud Waste & Abuse issues.
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