Last year the FBI estimated that between 3 percent and
10 percent of all health care spending in the U.S. went
towards fraudulent claims. Fraud has real effects on
health care costs and quality of care. The AmeriHealth
Corporate and Financial Investigations Department
(CFID) continues to add value to our fight against health
insurance fraud, waste, and abuse (FWA). CFID detects
and investigates potential areas of FWA with the help of
confidential information received from many stakeholders,
including providers, members, AmeriHealth associates,
and the general public.
Information received assists our analysts, auditors, and
investigators in determining whether potential FWA has
occurred. Some of the most common potential FWA
schemes reported to CFID over the past year include:
- billing for services not rendered
- health care identity fraud
- prescription fraud
- improper use of procedure codes
- claim lines billed with units exceeding the medically
unlikely edits (MUE) limits, according to the Centers
for Medicare & Medicaid Services
If you suspect health care fraud against you and/or
AmeriHealth, we urge you to report it. All reports are
confidential; you are not required to provide your name,
address, or other identifying information.
Submitting a report
You have three options for submitting a report:
- Submit the Online Fraud & Abuse Tip Referral
Form electronically.
- Call the confidential anti-fraud and corporate
compliance toll-free hotline at 1-866-282-2707
(TTY# 1-888-789-0429).
- Mail your report. Write a description of your
complaint, enclose copies of any supporting
documentation, and mail it to:
AmeriHealth
Corporate & Financial Investigations Department
1901 Market Street, 15th Floor
Philadelphia, PA 19103
As a result of CFID?s efforts last year, $65.8 million was
recovered in FWA-related claims and 38 fraud cases were
referred to law enforcement or regulatory agencies. In
addition, savings consisting of many times the recovered
amount were recognized through the detection,
prevention, and shutting down of improper payments and
schemes. Many of these recoveries and referrals started
with information someone provided to CFID.
Please join us in the fight against health care
fraud.