• 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 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 the FEP Fraud Hotline at 1-800-337-8440 to report possible fraudulent activity, or write:

      The United States Office of Personnel Management
      Office of the Inspector General Fraud Hotline
      1900 E Street, NW
      Room 6400
      Washington, DC 20415-1100

    Learn more