The laws prohibit:
- direct, indirect, or disguised payments in exchange for the referral of patients;
- the submission of false, fraudulent, or misleading claims to any government entity or third party payer, including claims for services not rendered, claims which characterize the service differently than the service actually rendered, or claims which do not otherwise comply with applicable program or contractual requirements; and
- making false representations to any person or entity in order to gain or retain participation in a program or to obtain payment for any service.
Employees, members, providers, and contractors can provide valuable information to alert Be Well Partners in Health to possible fraud and abuse issues. Individuals who report problems and concerns in good faith will be protected from any form of retaliation. All those who are employed are expected to act with utmost discretion and integrity in assuring that information received is acted upon in a reasonable and proper manner.
You may call the BE WELL PARTNERS IN HEALTH Help Line: 866.537.9695 or 312.940.4121
What is Health Care Fraud?
Health care fraud is recognized as any intentional misrepresentation of a significant fact submitted on, or in support of, a healthcare claim or application for healthcare coverage for the purpose of obtaining something to which you or someone else is not entitled. The National Health-Care Anti-Fraud Association (NHCAA) conservatively estimates that $68 billion of annual health care spending is lost to health care fraud. This leads to financial losses across the board, from higher premiums and out-of-pocket expenses for consumers, as well as reduced benefits and coverage. The issue is growing exponentially as health care fraud becomes more and more complex. Here at Be Well Partners in Health we realize the urgency in providing information regarding health care fraud so to prevent financial stress for the consumer.