Report fraud and abuse

To help keep the costs of health care down, Priority Health has a special team that checks for fraud and abuse. Fraud and abuse cost companies billions of dollars each year nationally, pushing health care prices up. We depend on you to report fraud and abuse to us when you see it.

What are fraud and abuse?
What can you do?
Frequently asked questions

What are fraud and abuse?

• Fraud is a kind of stealing, when someone takes something they don't have a right to have.
  Read the full legal definition.
• Medical identity theft is a growing area of fraud, where someone steals your ID card to get health care or prescriptions.
  Read the full legal definition.
• Abuse is using, or providing, health care services that are probably not needed, which creates unnecessary costs to you or to your insurance company.
  Read the full legal definition.

Here are some examples of fraud and abuse.

What can you do?

• Treat your health benefits ID card like a credit card.
  Don't let anyone borrow your card. If it is lost or stolen, call our Customer Service department right away.
• Protect yourself from medical identity theft.
  Learn more about how.
• Look carefully at each Explanation of Benefits (EOB) letter Priority Health sends you.
  After you've seen a doctor or had a test, we send you an EOB letter, telling you we've been billed for it. Make sure you had the visit or service listed there on the date it gives you. If it doesn't seem right, call the doctor or other health care provider and ask them to explain it to you. If you want some help reading an EOB, please call Customer Service.
• Report anything that seems like fraud or abuse.
  You don't have to tell us who you are.
  Here's how to report fraud or abuse.

Frequently asked questions

Q: Is it possible to receive a status report for my fraud and abuse complaint/tip?
A: No. Federal regulations do not allow us give out status reports or any information about how we are handling a complaint to anyone, not even the person who made the complaint. Please know that the information you provide to us will be taken seriously and we will take action on it according to our guidelines and legal requirements.

Q: Is there a reward for information I supply that identifies fraud and abuse?
A: No, there are no rewards for fraud and abuse information.

Need more information?

If you have additional questions or need further information, call or email Customer Service.