Last year, the Federal Bureau of Investigation estimated that between 3 and
10 percent of all health care spending in the U.S. went towards payment of
fraudulent claims. Fraud has 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.
Information received assists our analysts, auditors, and investigators in
determining whether potential FWA has occurred. Some of the most common
potential FWA schemes reported to CFID over the past year include:
- billing for services not rendered;
- health care identity fraud;
- prescribing of controlled substances for illicit purposes;
- improper use of procedure codes.
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.
Submitting a report
You can submit your report to us in one of three ways:
- Submit the Online Fraud &
Abuse Tip Referral Form electronically.
- Call the confidential anti-fraud and corporate compliance toll-free
hotline at 1-866-282-2707 (TTY: 1-888-789-0429
).
- Mail your report. Write a description of your complaint, enclose
copies of any supporting documentation, and mail it to: to:
AmeriHealth
Corporate & Financial Investigations Department
1901 Market Street, 42nd Floor
Philadelphia, PA 19103
As a result of CFID?s efforts last year, more than $100 million was
recovered in FWA-related claims and 88 fraud cases were referred to law
enforcement or regulatory agencies. Multiples of the recovered amount were
saved through the detection, prevention, and shutting down of improper payments
and schemes. Many of these recoveries and referrals started with information
someone provided to CFID.
Please join us in the fight against health care fraud.