​Health care fraud schemes have significant effects on health care costs and quality of care. 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.

At AmeriHealth, the Corporate and Financial Investigations Department detects and investigates potential areas of fraud, waste, and abuse (FWA) with the help of confidential information received from many stakeholders, including providers, members, employees, and the public. The information received assists our analysts, auditors, and investigators in examining allegations of FWA. 

There are several common types of fraud in the health insurance sector, which can include:

• performing medically unnecessary surgeries or treatments to generate higher insurance payments
• falsifying of tests to justify unnecessary medical actions
• accepting kickbacks for patient referrals
• billing insurers for services or procedures that were not rendered
• upcoding, which is the act of billing for more expensive services or procedures than were actually performed
• unbundling, which is the act of billing each step of a procedure as an individual procedure
• misrepresenting non-covered treatments
• waiving patient payments (copays or deductibles) and charging these costs to the insurer or benefit plan
• billing a patient for more than their copay or deductible amount
• prescription fraud

What you can do

If you suspect health care fraud against you and/or AmeriHealth, 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​

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