Health care fraud and abuse

• Billed services not performed by a provider of care
• Intentionally misrepresenting facts regarding the payment of benefits
• Routinely waiving co-payments or deductibles
• Billing for medically unnecessary items or services
• “Unbundling” claims, or separate billing procedures instead of using a more appropriate global billing procedure
• Upcoding claims, or billing at a higher rate than is appropriate for the item or service provided
• Misrepresenting facts affecting eligibility for benefits, such as: employment status, health history, marital or student status, identity

• Review your Explanation of Benefits (EOB) and compare to the services billed by your provider of care. If there is a difference between your EOB and medical bill, contact MHBP.
• Protect your health insurance information and do not share your health insurance plan card with anyone other than an authorized health care provider or your insurance plan
• Be suspicious of free medical services that require your insurance information.
• Inform us of any provider of care that routinely waives your copayments or deductibles
• For more tips on identifying, preventing and reporting fraud visit the OPM website.

Call our Special Investigations Unit (SIU) dedicated hotline to report suspected fraud and abuse activities at 1-800-338-6361 (TTY: 411) and select option 2. Simply leave a message and it will be reviewed promptly. You may also contact our 24 hours, 7 days a week customer service line at 1-833-497-2416 (TTY: 711) to make a report (except major holidays). If we do not resolve the issue you may call the OPM/OIG health care fraud hotline at 1-202-418-3300.

For more information on health care fraud and abuse, refer to the official Plan brochure.

Visit the U.S. Office of Personnel Management/Office of the Inspector General website »

Visit the National Health Care Anti-Fraud Association website »

Visit the Coalition Against Insurance Fraud website »

Visit Stop Medicare Fraud website »

If you were subject to the data breaches of the U.S. Office of Personnel Management and its contractor, and you experienced an out-of-pocket loss after the breaches, you could be eligible for a payment from a class action settlement.

The Settlement Agreement and more information on the lawsuit and your rights are available at OPMDataBreach.com or by calling toll-free 1-855-917-3567.