Health Care Fraud

The cost of health insurance fraud and abuse is estimated to be as much as $54 billion dollars each year. Efforts to identify and report fraud can save tens of millions of dollars. That’s why New York's health insurers, working with the New York Health Plan Association and the National Health Care Anti-Fraud Association, are joining together in a campaign to educate the public about fraud and its costs and to get consumers involved in the effort to reduce fraud.

What is Fraud?

Fraud is stealing, which is a crime, and it is a crime that affects everyone. When people commit health care fraud crimes, those actions contribute to rising costs of health care. Reducing health care fraud and abuse can help contain rising health care costs.

What is Considered Health Care Fraud?

The most common kind of fraud involves a false statement, misrepresentation or deliberate omission that is critical to the determination of benefits payable. The most common examples of health care fraud include, but are not limited to:

By its nature, health care fraud revolves around the exploitation of patients and their health insurance information, and as such, it involves much more than financial loss. Fraud also involved the creation of false medical histories for the persons in whose names those false claims are filed. Depending on the nature of the fraud, some providers put patients at physical risk solely for the purpose of generating falsified claims.

What Can Consumers Do to Fight Health Care Fraud?

Consumers can take the following simple steps to help reduce fraud and abuse:

The following websites offer more information about fraud and what you can do to help prevent it:

National Health Care Anti-Fraud Association

Coalition Against Insurance Fraud

Medicare Fraud

New York Anti-Fraud Campaign

Since 2000, HPA and several member plans have partnered with the National Health Care Anti-Fraud Association to run a series of radio and print ads throughout New York State aimed at alerting the public to be aware of health care fraud in an effort to increase detection and prevention. These ads run twice yearly.

To get a PDF copy of the current Anti-Fraud ad, click HERE.

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