The National Health Care Anti-Fraud Association estimates that 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) detects and investigates potential areas of health insurance fraud, waste, and abuse (FWA) with the help of confidential information received from many stakeholders, including providers, members, employees, and members of the public. 

The information we receive assists our analysts, auditors, and investigators in examining allegations of FWA. Some of the most common allegations of FWA schemes reported to us over the past year include: 

• billing for services not rendered
• prescription fraud
• enrollment of ineligible members, specifically in Affordable Care Act policies
• inappropriate non-schedule II pharmacy and durable medical equipment utilization resulting from telemarketing schemes
• inappropriate use of specific service types (e.g., wellness) 

Last year, we recovered significant funds through the detection, prevention, and avoidance of improper payments and schemes. Many of these recoveries and fraud case referrals started with information someone provided to CFID. Please join us in the fight against health care fraud. 

How you can report suspected 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 in any of the following ways: 

• 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

More information

For additional information on how you can help fight fraud, waste, and abuse, please visit the Anti-fraud and Financial Investigations section of theAmeriHealth New Jersey and AmeriHealth Pennsylvania websites.