Fraud & Abuse

Fraud is a major concern in the health care industry. It results in a loss of billions of dollars each year, and stress to consumers who are affected by it. Access2day Health is working to eliminate all instances of fraud that impact our customers, whether it is health care fraud or electronic fraud, such as fake emails and web sites. Your help is needed in this effort. By reviewing the information provided and reporting any instances of suspected fraud, we can work together to ensure the security of our customers’ information and control the rise in health care costs.

Protect Your Identity & Health
You’ve probably heard about the dangers of identity theft—it can damage your credit, your reputation, and cost you time and money to undo the damage. But did you know it can endanger your health and can impact your health negatively.

Why should I be concerned about identity theft?
Identity theft not only causes frustration, anger and stress, it can rob you of your good name and destroy your credit. Victims spend a lot of time and money trying to straighten out issues related to identity theft. It can take months or years to undo the damage.

Here are ways that thieves use the information they steal from you:
They use your credit card number to make purchases on your account.
They open new credit card accounts in your name and run up charges.
When the bills aren’t paid, it shows up on your credit report.
They get loans for houses or cars in your name.
They get identification, such as a driver’s license, with your name and their picture.
They drain your bank account by authorizing electronic transfers or writing counterfeit checks.
They open bank accounts in your name and write bad checks.
They file fraudulent tax returns in your name.
They commit crimes with your name, resulting in warrants for your arrest.

How can identity theft affect my health?
If someone steals your identity and uses it to receive healthcare services, your medical history could be compromised and result in:
Receiving the wrong blood type if you ever need a transfusion;
Getting a medication you’re allergic to;
Being refused medication or therapy because your medical history shows you have an allergy to it;
Difficulty getting life or health insurance; and
Endangering your employment if substance abuse is listed.

What can I do to protect my identity?
Protecting your identity is important for numerous reasons, one of which is safeguarding your health. Nothing is foolproof against the best identity thieves, but by taking a few precautions, you can decrease your chance of becoming a victim.
Protect your Social Security number. Don’t have it printed on your driver’s license, checks or other materials, and don’t carry your Social Security card in your wallet. Give out your Social Security number only when it’s absolutely necessary.
Safeguard your Benefits’ ID card.
Shred paperwork that contains personal or financial information before discarding it. This includes preapproved credit card and loan applications, and materials that include your personal health information.
Avoid giving out personal information to unknown businesses or people over the phone, through the mail or on the Internet.
When entering personal or financial information on the Internet, be sure the web site you are using is secure. Look for the lock icon on your browser or https in the web address. This means the site is encrypted and has a security certificate. Also, be sure to install antivirus and firewall software on your computer.
Don’t click on links in unsolicited emails.
Destroy expired credit and ATM cards.
Order an annual copy of your credit report and review it for discrepancies.
Review bills, bank statements and other financial accounts for suspicious activity.

What should I do if I’m a victim of identity theft?
If you suspect that your information has been stolen, follow these steps immediately:
Place a “Fraud Alert” on your credit reports and review them carefully. This will make it harder for thieves to open accounts in your name or alter existing accounts. Call any of the three nationwide consumer reporting companies to put a fraud alert on your credit report:
Equifax: 800.525.6285
Experian: 888.EXPERIAN (397.3742)
TransUnion: 800.680.7289
Close any accounts that you suspect have been tampered with or opened fraudulently. Speak with someone in the security or fraud department. Follow up in writing, including copies of supporting documents. Keep the original supporting documents with copies of your letters in your files.
File a police report. This will come in handy if creditors require proof of the crime.
Report the theft to the Federal Trade Commission (FTC). This helps law enforcement officials investigate identify theft and increases the chance of stopping the perpetrators.

To file a report with the FTC:
Call: 877.ID-THEFT (438-4338).
Send a letter to:
Identity Theft Clearinghouse
Federal Trade Commission
600 Pennsylvania Avenue, NW
Washington, DC 20580

For medical identity theft:
Contact your healthcare provider and request a correction.
Notify your health insurance company of the incident.
In addition to filing a police report and reporting the incident to the FTC, report it to the Social Security Administration and Medical Information Bureau.

Additional resources
Federal Trade Commission:
World Privacy Forum:
United States Postal Inspection Service:
Identity Theft Resource Center:
Privacy Rights Clearinghouse:
Social Security Administration:
Medical Information Bureau:

How to Identify Fraud & Abuse
Insurance fraud costs you money in the form of higher health care costs. In fact, losses to fraud account for an estimated 10% of what’s spent on health care annually. We are dedicated to stopping fraud. However, we still need help from people like you.
Helping uncover fraud is easy. All you have to do is:
1. Know what to look for
2. Keep watch
3. Report suspected fraud and abuse

What to look for:
Common types of health care fraud include:
Filing when services were not performed
Including misleading information in an application for coverage - a person lies about a relationship to a contract holder or deliberately gives incorrect information to receive benefits not entitled to.
Using ID cards that belong to someone else—using another person’s insurance ID card to receive or pay for services one isn’t eligible for.
Keeping Watch:
Read any Explanation of Benefits (EOB) you receive carefully
Take note if you seem to be paying unusually high charges for regular services
Understand what services your benefits provide for

Report Suspected Fraud and Abuse:
We need your help in identifying cases of fraud and abuse. After all, only you know the services you received. If you see something on an Explanation of Benefits (EOB) that doesn’t look right or if it lists a service you don’t think was performed, contact your doctor or health care provider to question it.
If you still have questions or concerns after talking to your provider, complete the online form to report suspected fraud and abuse or call our fraud hotline at: 1.800.824.4391.