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 LifeWise Combats Fraud

    At LifeWise, 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. We have a Special Investigations Unit to look into suspected instances of fraud. We also have a Fraud Hotline you can call anytime (800-360-9535) to report fraud.

    How You Can 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, incorrect billed services or dates of service and any false statements
    • Call our Fraud Hotline, 24/7 at 800-360-9535 to report possible fraudulent activity