Fraud and abuse

What is healthcare fraud?

Healthcare fraud occurs when a false claim is deliberately submitted to a health plan. It affects virtually everyone, taking critical dollars out of our already financially overwhelmed healthcare system.

The National Healthcare Anti-Fraud Association estimates that as much as $50 billion is lost annually in the United States to healthcare fraud. The U.S. General Accounting Office reports that this figure might even be as high as $120 billion. It’s easy to see why losses of that magnitude affect costs for consumers, providers, and insurers.

Those who commit healthcare fraud can face fines and/or jail terms. For example, making false or misleading statements on a health plan application carry a penalty of up to five years in prison.

How does Premera combat fraud?

At Premera, it’s critical that we do all we can to prevent, detect, and investigate healthcare fraud and abuse by providers, producers, employer groups, or members. Premera has a special investigations unit to look into suspected instances of fraud. We also have a fraud hotline you can call anytime 888-844-8985 (TTY: 711) to report fraud.

How can you prevent fraud?

  • Sign only one claim form per visit
  • Guard your health insurance ID number as you would credit card information
  • Check your explanation of benefits (EOB) for inflated charges, incorrectly billed services or dates of service, and any other false statements
  • Call our fraud hotline, 24 hours a day, 7 days a week, at 888-844-8985 (TTY: 711) to report possible fraudulent activity