Each year the FBI estimates that between 3 and 10 percent of all health care
spending in the U.S. is wasted on fraudulent claims. Fraud has material impact
on health care costs and quality of care. The AmeriHealth Corporate and
Financial Investigations Department detects and investigates potential areas of
health insurance fraud, waste, and abuse with the help of confidential
information received from providers, members, employees, and members of the
general public.
The information we receive assists our analysts, auditors, and investigators
in determining whether potential fraud, waste, or abuse has occurred. Some of
the most common potentially suspicious activity reported to us over the past
year include:
- billing for services not rendered
- health care identity fraud
- prescribing of controlled substances for illicit purposes
- improper use of procedure codes
In addition to the above-mentioned activity, please be mindful of irregular
requests from pharmacies for pain creams, diabetic supplies, braces, etc.
Join us in the fight against health care
fraud
If you suspect health care fraud against AmeriHealth and/or you, we urge you
to report it. All reports are confidential. You are not required to provide
your name, address, or other identifying information. You can report suspicious
activity in any of the following ways:
- Online. Submit the online Fraud & Abuse Tip Referral Form.
- By phone. Call the confidential anti-fraud and corporate compliance
toll free hotline at 1-866-282-2707 (TTY: 1-888-789-0429).
- By mail. Write a description of your complaint, enclose copies of
any supporting documentation, and mail it to:
AmeriHealth
Corporate & Financial Investigations Department
1901 Market Street, 42nd Floor
Philadelphia, PA 19103