Claims Fraud Information
In an effort to keep costs low for everyone, IMG actively pursues all claims fraud cases. Below is more information on claims fraud and the procedures we have in place to combat this problem.
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.
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.
Billions Lost Each Year
According to the United States General Accounting Office, fraud costs an estimated $110 billion U.S. Dollars annually or as much as 10 cents on every dollar spent on health care.
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 website. We allow anonymity to the caller or the person reporting the fraud.