Healthcare fraud and abuse increases costs and may result in lower benefits and higher premiums. Please be informed so you'll know how you can help.
What is Healthcare Fraud and Abuse?
Healthcare fraud is an intentional deception or misrepresentation performed by an individual or entity, knowing the misrepresentation could result in some unauthorized benefit to the individual, entity, or some other party.
Healthcare abuse is any activity that misuses the healthcare system, but does not meet the statutory definition of fraud. Examples may include over-utilization of services, billing for one service when a lesser service was performed, and billing for procedures individually when they should be billed as a group.
PEHP has developed a special investigative unit (SIU) to combat the growing trend in healthcare fraud and to assist in stemming rising healthcare premiums and possible loss of benefits.
Keys to Fighting Fraud
How Healthcare Fraud Impacts You
It can lead to increased healthcare premiums. decreased benefits, and possible falsification of medical records, including treatment history.
How You Can Help
Review your explanation of benefits (EOBs) and quarterly statements received from PEHP for charges that seem incorrect or charges for services you don’t recall receiving. Report your concerns to our 24-hour confidential hotline 888-475-8376. You may also submit a confidential, anonymous report electronically by clicking here.