Eliminating fraud, waste & abuse saves more than $1 of each $10

Priority Health is committed to partnering with physicians to enable you to deliver the highest quality care that optimizes clinical outcomes and ensures the best care experience while eliminating avoidable costs. As part of our commitment to making affordable, excellent health care available to all, we’re working to reduce fraud, waste and abuse in the health care system. Experts estimate that more than $1 out of every $10 spent on health care in the United States is due to fraud, waste and abuse in the health care system. That’s why we have a special team fighting fraud, waste and abuse by:

• Helping your patients understand the negative impact on the health care system and what can be do done to reduce them.
• Auditing suspicious claims (medical and pharmacy) to ensure claims are billed accurately.
• Ensuring the primary payer always pays first through coordination of benefits, third party liability to pay claims (workers’ comp, personal injury, auto, accident), recovery of duplicate claim payments and ensuring Medicare pays when appropriate.
• Investigating and reviewing reports of potential fraud, waste and abuse.

We’re also encouraging your patients to report anything that appears to be medical fraud or abuse.

Examples may include being charged for services they didn’t receive or someone “borrowing” a friend’s Priority Health ID card to get health care.

Learn more about our Fraud and Abuse program.

If you ever have questions about our fraud and abuse efforts, please contact your provider account representative or provider account coordinator.

Potential cases of fraud, waste or abuse can be reported to us through the Priority Health Compliance Helpline at 800 560-7013.

Topics: Priority Health updates