110 Billion U.S. Dollars Lost Each Year
According to the United States General Accounting Office, fraud costs an
estimated $110 billion annually or as much as 10 cents on every dollar spent on
health care.
Definition and Penalty
U.S. Code, Title 18, Ch. 63, Sec 1347 contains a federal statutory
definition of health fraud as follows:
Whoever knowingly and willfully executes or attempts to execute a scheme:
- to defraud any health care benefit program;
- or to obtain, by means of false or fraudulent pretenses, representations,
or promises, any of the money or property owned by or under the custody
or control of any health care benefit program in connection with the
delivery or of payment for health care services, shall be fined under
this title or imprisoned not more than 10 years, or both.
Deterring Fraud
The best way to combat health care fraud is to have procedures in place
to deter and identify fraud before the dollars are paid out. At IMG, we provide
fraud education and training to the claims department. We call the patient to
verify treatment when the bills look suspicious. We ask that employers educate
their employees to review their bills, ask questions and to carefully review
the Explanation of Benefits worksheets. If the patient realizes the treatment
never took place, they need to notify IMG immediately.
Reporting Fraud to IMG
Our Fraud Unit is designated for policy holders of IMG Insurance
Programs. Please report any fraudulent activity by calling 1-800-628-4664
(001-317-655-4500 outside the United States) or E-mail us here on our Web site.
We allow anonymity to the caller or the person reporting the fraud.