Report fraud & abuse
Fraud and abuse take place every day and may go unnoticed. That's why the SDCERA plans have a Fraud and Abuse program to identify and detect fraud and abuse. If you suspect that the plan, a health care professional or someone you know has been a victim of health care fraud, it's important to report your concerns.
What is fraud?
What is abuse?
|Fraud is when someone deliberately practices deceit in order to benefit from it. Some types of fraud are:
||Abuse is improper use of the benefits and/or services being provided. Some types of abuse are:
What can I do to protect myself?
- Report suspicious billing
For claims questions, billing errors or provider disputes please contact a customer service representative at the phone number listed on your medical identification card.
- Review your policy and benefit statements
Review your policy, Explanation of Benefits (EOB) statements and any other paperwork you receive related to your health care coverage. Make sure you received the treatments for which your health plan was charged and question suspicious expenses.
- Beware of "free" offers, including waiver of copay or coinsurance
Offers of "free" services, including waiver of copay or coinsurance , are often fraud schemes designed to bill you and your health plan illegally for thousands of dollars of treatments you never received. Do not give your policy number in exchange for getting a "free" consultation.
- Protect your health plan ID card like your credit card
In the wrong hands, a health plan ID card is a license to steal. Don't give policy numbers to door-to-door salespeople or telephone solicitors. Never give your card to a friend to use for medical services.
How do I report fraud and abuse?
If you have questions about fraud and abuse, or to report suspected fraud or abuse, please call customer service at the number indicated on your ID card. Or, contact us.
If you think you've been a victim of identity theft or fraud, call any of these numbers:
- Call toll-free 1-800-MEDICARE (1-800-633-4227). TTY, call toll-free 1-877-486-2048, 24 hours a day, 7 days a week.
- The Fraud Hotline of the HHS Office of Inspector General, toll-free at 1-800-HHS-TIPS (1-800-447-8477). TTY, call toll-free 1-800-377-4950. You can also email HHSTips@oig.hhs.gov.
- The Federal Trade Commission's ID Theft Hotline toll-free at 1-877-438-4338 to make a report. TTY users, call toll-free 1-866-653-4261.
You can always remain anonymous.