Report Health Care Fraud
Health care fraud is costly. Studies show between 3 percent and 10 percent of our national health care spending is lost to fraud. And that adds up to higher doctor's fees and higher health plan premiums for you.
GEHA is committed to fighting health care fraud and abuse, and to helping you get the best value for your health care dollars. This information will help you recognize health care fraud, and offer tips on how to help prevent it.
Remember, health care fraud is a federal criminal offense. If you suspect that a provider or a consumer is committing health care fraud, you can report the information to GEHA by email at email@example.com.
It is a crime to knowingly provide false or misleading information for the purpose of obtaining financial benefits.
What is not fraud?
- Routine billing issues and delays in payments
- Disagreements about claims
What may be fraud?*
- Billing for services that were never provided
- Billing for services by a licensed doctor when services were actually provided by a non-licensed person
- Billing for excessive or unnecessary medical supplies
- Billing for medical equipment before delivery or billing for medical equipment after it has been returned to the vendor
- Billing for medical equipment not delivered
- Alterations on billings
What is waste?
- Performing large number of laboratory tests on patients when the standard of care indicates that only a few tests should have been performed on each of them
- Medication and prescription refill errors, and
- Failure to implement standard industry waste-prevention measures.
What is abuse?
- Services or treatment not medically necessary
- Treatment not consistent with a diagnosis
How to help prevent fraud:
- Review your explanation of benefits carefully to make sure you received the services indicated. Notify the plan immediately if services were not rendered.
- Beware of "free" offers.
- Never provide your insurance card to anyone other than the provider of service.
- If it sounds too good to be true, pass it up. It's probably not true.
- Be careful with providers that refer to alternative treatments or remedies.
How to report suspected health care fraud or abuse
If you have information you want to share with GEHA, send us an email at firstname.lastname@example.org or call us at (800) 821-6136 and explain the situation. If we do not resolve the situation, call the Health Care Fraud Hotline at (877) 499-7295.
For more information about stopping health care fraud, go to OPM's health care fraud webpage.
*These activities may constitute fraud if they are done intentionally.