Fraud and Abuse

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 Health Care 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 carries a penalty of up to five years in prison.

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. Please contact the Special Investigations Unit regarding any suspected fraud or abusive billing concerns.

• 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 data of service, and any false statements.
• Receiving bills for services not received and/or not rendered.
• Not satisfied with your provider visit, contact customer service.

• Send us an email at STOPFraud@premera.com. All information remains confidential and protected.
• If you prefer to call and leave a message with your contact information or anonymous, call our Fraud Hotline 24/7 at 800-848-0244 or 425-918-5500.
• Leave it to the professionals to investigate.
• By reporting, you are helping combat Fraud, Waste and Abuse.

The term "phishing" refers to the attempt to acquire sensitive information such as credit card details, Social Security numbers, and other personal protected information by falsely posing as a trustworthy entity, usually in an electronic communication (telephone, email, instant messaging).

The purpose of phishing is to steal your identity or personal protected information through deception, and to use that information for fraudulent activity and scams. Phishing attempts may use trusted organization logos, names, and styles to deceive victims into providing personal protected information.

Legitimate emails from Premera will never ask you for your username/password, Social Security number, financial data, or other personal protected information. We will also never threaten to cancel your coverage if you do not supply this information. If Premera contacts you via phone, it will only be in followup to your previous inquiry and we will not ask for your personal protected information.

• Very generic greetings or mistakes in the greeting.
• Misspellings or grammatical errors.
• A false sense of urgency, such as "you must take immediate action or we will cancel your contract."
• Links in email that take you to non-Premera sites.
• Telephone calls from unrecognized or suspicious area codes.
• Callers who are unable to answer basic questions such as which providers are in the network or the status of your claims.

Here are some tips on how to safeguard your personal protected information from phishing scams and other fraudulent behavior:

• Know that Premera will never contact you for your personal protected information.
• Do not provide your personal protected information to anyone who calls or emails you unrelated to an inquiry you made.
• Proceed with caution—do not make any decisions before investigating the details.
• Never email personal or financial information unless via our secure member site.
• Safeguard your member ID card at all times, and do not give out your information contained on the card to anyone other than your doctor, hospital, or pharmacy.
• Hang up on fake phone requests.

• Send us an email at STOPFraud@premera.com. All information remains confidential and protected.
• If you prefer to call and leave a message with your contact information or anonymous, call our Fraud Hotline 24/7 at 800-848-0244 or 425-918-5500.
• Leave it to the professionals to investigate.
• By reporting, you are helping combat these scams.