In the U.S., fraud undermines our health care system, costing honest provider, insurers and patients an estimated tens of billions of dollars every year. Taking advantage of the trust between health care providers and patients, fraudulent players drain public and private resources for their own financial benefits.
In New Jersey, Horizon’s Special Investigations team works to proactively identify fraudulent behaviors and investigate the claims of concerned members. In the process, the SI team recovers to averts the loss of millions of dollars in fraud each year
Four quick tips from investigators to help prevent fraud:
Protect your health insurance card
You know to take good care of your credit cards and social security card but you should be equally diligent with your member card. Stolen cards are often sold to fraudsters, who use them to file fake claims and you can be hit with unexpected co-payments.
Don’t share your car number over the phone
A popular fraud scheme is to call a person, offer “free” medication or other services, and then request the member number. You’ll likely get the prescription, and also a heft bill from a bogus insurance claim.
Talk to your doctor
During each visit, make sure you understand exactly what procedures or treatments you are receiving. If you have questions or something doesn’t see right, speak up.
Read each Explanation of Benefits (EOB) carefully
An electronic or paper EOB captures claims and payment information from a visit to a health care professional. Fraudulent activity to look for when reading an EOB include billing for services you did not receive, an unusually high charge for a routine service, or performing medically unnecessary services. As a best practice, if you have a question or concern on you EOB, call your broker.
Cosmo Insurance Agency is an independent insurance agency serving surrounding communities in New Jersey. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating the latest in technology-based tools and laws on healthcare, employee benefits, life insurance and finance, we keep our clients up-to-date with the plans that encompass all of their needs, whether it is individual or group insurance.
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