Healthcare fraud costs Americans billions of dollars each year. Here at Scott & White Health Plan, we are dedicated to protecting you against fraudulent conduct.
According to the Department of Health and Human Services, “fraud is the intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes, knowing that the deception could result in some unauthorized benefit to himself/herself or some other person.” Some examples of Medicare fraud are:
- Billing Medicare for services or items you never received.
- Billing Medicare for services or equipment that is different from what you received.
- Use of another person's Medicare card to get medical care, supplies, or equipment.
- Billing Medicare for home medical equipment after it has been returned.
Fraud Protection and Prevention
Because Medicare fraud costs the Medicare program millions of dollars annually, people with Medicare pay for it with higher premiums. You can help prevent, avoid, and detect fraud by following some simple steps:
- Review your monthly Scott & White Health Plan Explanation of Benefits (EOB) and ensure that you received all services stated on the document. The EOB is a listing of medications that you received, the co-payment that you paid and the amount that was billed to your insurance for the previous month.
- Review your Medicare Summary Notice (MSN) and ensure that you received all services stated on the document. The MSN shows what Medicare was billed for, what Medicare paid and what you owe.
- Don't ever give out your Medicare Health Insurance Claim Number (on your Medicare card) except to your physician or other Medicare provider.
- Be cautious when you are offered free testing or screening in exchange for your Medicare card number.
If you find a suspicious charge on your EOB or MSN, call your provider first. It could be a simple error that can be easily corrected. If you still suspect fraud after speaking with them, you can contact the Scott & White Health Plan Hotline or contact the Office of the Inspector General Hotline. The hotlines offer a confidential means of reporting information.
Contact Scott & White Health Plan If You Suspect or Want to Report Fraud:
Mary Ann McLean Compliance Officer: 1-254-298-3494
Scott & White Alertline Website
Scott & White Health Plan - Compliance Department
1206 West Campus Drive
Temple, TX 76502
Contact the Office of the Inspector General:
Office of the Inspector General
HHS TIPS Hotline
P.O. Box 23489
Washington, DC 20026
If you have specific information proving Medicare fraud, please provide as much identifying information as possible regarding your concern. Such information should include the subject's name, address and phone number. Details regarding the allegation should include the basics of who, what, when, where, why, and how.
How Is Scott & White Health Plan Working to Minimize Fraud?
Scott & White Health Plan’s Special Investigative Unit (SIU) and auditors utilize fraud detection software for medical and prescription claims, investigate any suspicious claims, and follow necessary actions.
For additional information on how to protect Medicare and yourself from fraud, download the official Centers for Medicare and Medicaid Services booklet.