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Fraud and Abuse

Fraud is a major concern in the healthcare industry that costs tens of billions of dollars each year and harms patients and providers. We rely on providers and patients as a critical frontline resource for help in combatting fraud crimes and unnecessary costs.

We need your help to make a difference in reducing fraud and abuse. Anyone can remain anonymous when reporting healthcare fraud and abuse.

Information for Providers

Healthcare fraud and abuse can include:

  • Billing for services the patient never received.
  • Filing claims for unnecessary procedures.
  • Filing a claim for a more expensive procedure than the one performed.
  • Duplicate submission of a claim for the same service.
  • Billing for durable medical equipment not ordered or provided.
  • Billing for a covered service when the service provided wasn't covered.

To report possible healthcare fraud and abuse:

Resources:

Information Related to Patients

Examples of healthcare fraud and abuse can include:

  • Using an expired or fraudulent identification card to get medical services or medications.
  • Lending an ID card to someone who isn't entitled to it.
  • Adding someone who isn't eligible for coverage to a contract.
  • Not removing someone from a policy when that person is no longer eligible.
  • Forging or altering bills.
  • Misrepresenting physical conditions or medical history in order to obtain multiple prescriptions.

Our member site, AlabamaBlue.com, provides information for patients to identify, prevent and report fraud and abuse.