Fraud and Abuse

HomeFraud and Abuse

While the majority of the health care system is populated by upstanding, honest citizens, there are a few individuals and medical providers who try to cheat the system, and by doing so they increase health care costs for everyone.

Health care fraud is intentional deception or false representation of the facts in order to receive greater benefits or payment.

Health care abuse is conduct that disregards acceptable business/medical standards in order to gain greater benefits or payment.

Here are a few examples of fraud and abuse in the health care system.

  • Submitting claims for services you did not have or use
  • Putting false information on claims or medical records
  • Representing information incorrectly for any services provided
  • Billing for services at a higher price than what they actually cost or billing for services not provided
  • Failing to disclose coverage under another health insurance plan
  • Continuously waiving deductibles
  • Failing to maintain adequate medical or financial records
  • Continuously making claims for services that aren’t medically necessary

What is Medical Identity Theft?

If someone steals your personal information and uses it to get medical services/care, to buy prescription drugs or to submit false bills to Medicare or an insurance provider in your name, you are the victim of medical identity theft and should report it immediately.

Learn More

Report Fraud/Abuse

You can report fraud online or by phone

  • Contact us at McCall Insurance Services
  • Contact your insurance company directly
  • Visit STOP Medicare Fraud

Fraud/Abuse/Theft Hotlines

Office of Inspector General
Call: 1-800-447-8477
TTY: 1-800-377-4950

Medicare
Call: 1-800-633-4227
TTY:1-877-486-2048

 

We at McCall Insurance Services boldly support the effort, and we encourage you to check your bill and question your charges. We’ll even go over your bills with you if you’d like, so just give us a call! 

Please take action and do your part to prevent exploitation of the health insurance and health care system.