The National Health Care Anti-Fraud Association estimates that the financial
losses due to health care fraud are in the tens of billions of dollars each
year. Health care fraud schemes continue to grow in complexity and seriousness
and have real effects on health care costs and quality of care. The AmeriHealth
Corporate and Financial Investigations Department (CFID) continues to add value
to our fight against health insurance fraud, waste, and abuse (FWA). CFID
detects and investigates potential areas of FWA with the help of confidential
information received from many stakeholders, including providers, members,
employees and the general public.
The information we receive assists our analysts, auditors, and investigators
in examining allegations of potential FWA. Some of the most common concerns
and/or suspicions reported to CFID over the past year include:
- billing for services not rendered
- prescription fraud
- inappropriate non-schedule II pharmacy and durable medical equipment
utilization resulting from telemarketing schemes
- inappropriate use of specific service types (e.g., wellness)
Help your patients prevent fraud and
abuse
Health care fraud and abuse is a national problem, and your assistance is
vital in helping us to prevent the problem. Simple tips you can share with your
AmeriHealth patients, our members, that may help prevent fraud and abuse
include:
- review your Explanation of Benefits to ensure accurate dates of service,
name of providers, and types of services reported;
- protect your insurance card and personal information at all times;
- count your pills each time you pick up a prescription;
- research your providers with your state's medical boards;
- report suspected fraud and abuse as soon as possible.
Join us in the fight against health care
fraud
If you suspect health care fraud against AmeriHealth and/or you, we urge you
to report it. All reports are confidential. You are not required to provide
your name, address, or other identifying information. You can report suspicious
activity using any of the following methods:
- Online. Submit the online Fraud & Abuse Tip Referral Form.
- By phone. Call the confidential anti-fraud and corporate
compliance toll free hotline at 1-866-282-2707
(TTY: 1-888-789-0429), 8:30 a.m. to 4:30 p.m.,
Monday through Friday.
- By mail. Write a description of your
complaint, enclose copies of any supporting documentation, and mail
it to:
AmeriHealth
Corporate & Financial Investigations Department
1901 Market Street, 42nd Floor
Philadelphia, PA 19103
Learn more
For additional information on how you can help FWA, please visit the
Anti-fraud and Financial Investigations section of the AmeriHealth New Jersey and AmeriHealth Pennsylvania websites.