About Fraud Prevention

Health care fraud, waste and abuse have a negative effect on the health care industry and our nation. Health care fraud costs billions of dollars each year. It impacts all of us in the long run.

Health care fraud leads to:

• Higher health care costs
• Limited health care resources
• Lower consumer confidence in our health care system

Examples of health care fraud include billing for:

• A service that was never performed
• A more expensive service, supply or piece of equipment other than what was really provided
• The same service twice

We all need to work together to reduce health care fraud.

• Members
• Providers
• Employer groups
• Producers
• Local, state and federal agencies and law enforcement

Special Investigations Department (SID) staff includes people from diverse backgrounds such as:

• Medical providers (doctors and nurses)
• Professional coders
• Insurance industry experts
• Law enforcement

SID also has a Data Intelligence Unit to partner with SID investigators to find and stop fraud, waste and abuse. When appropriate, SID refers fraud cases for criminal prosecution.