How to prevent fraud, waste & abuse

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

What are fraud and abuse?

  • Fraud is a dishonest act. A person or company commits fraud knowing it is wrong and could result in their getting money, services or other benefits they have no right to.
  • Medical identity theft is a growing area of fraud, where someone steals personal information and uses it to get, or to bill for, health care services or prescriptions.
  • Abuse is using, or providing, health care services that are probably not needed, which results in unnecessary costs to you or to your insurance company.

Read the complete legal definitions.

See some common examples of fraud, waste and abuse.

Protect yourself from fraud and abuse

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 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 fraud and abuse as soon as possible

Report anything that seems like fraud or abuse. You don't have give your name. You may remain anonymous. Learn how.

Need more information?

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