Fraud and abuse

  • Healthcare fraud

    What is healthcare fraud?

    Healthcare fraud occurs when a false claim is deliberately submitted to a health plan. It affects virtually everyone, taking critical dollars out of our already financially overwhelmed healthcare system.

    The National Healthcare Anti-Fraud Association estimates that as much as $50 billion is lost annually in the United States to healthcare fraud. The U.S. General Accounting Office reports that this figure might even be as high as $120 billion. It’s easy to see why losses of that magnitude affect costs for consumers, providers and insurers.

    Those who commit healthcare fraud can face fines and/or jail terms. For example, making false or misleading statements on a health plan application carry a penalty of up to five years in prison.

    How LifeWise combats fraud

    At LifeWise, it’s critical that we do all we can to prevent, detect, and investigate healthcare fraud and abuse by providers, producers, employer groups or members. LifeWise has a Special Investigations Unit to look into suspected instances of fraud. We also have a Fraud Hotline you can call anytime (800-360-9535) to report fraud.

    How you can prevent fraud

    • Guard your health insurance ID number as you would credit card information
    • Check your Explanation of Benefits (EOB) for inflated charges, incorrect billed services or dates of service and any false statements
    • Call our Fraud Hotline, 24/7 at 800-360-9535 to report possible fraudulent activity

    Phishing scams

    What is phishing?

    The term “phishing” refers to the attempt to acquire sensitive information such as credit card details, Social Security numbers, and other personal protected information by falsely posing as a trustworthy entity, usually in an electronic communication (telephone, email, instant messaging, etc.).

    The purpose of phishing is to steal your identify or personal protected information through deception, and to use that information for fraudulent activity and scams. Phishing attempts may use trusted organization logos, names and styles to deceive victims into providing personal protected information.

    Legitimate emails from LifeWise will never ask you for your username/password, Social Security number, financial data, or other personal protected information. We will also never threaten to cancel your coverage if you do not supply this information. If LifeWise contacts you via phone, it will only be in follow up to your previous inquiry and we will not ask for your personal protected information.

    How to identify a phishing scam

    • Very generic greetings or mistakes in the greeting
    • Misspellings or grammatical errors
    • A false sense of urgency, e.g. "you must take immediate action or we will cancel your contract"
    • Links in email that take you to non-LifeWise sites
    • Telephone calls from unrecognized or suspicious area codes
    • Callers who are unable to answer basic questions such as which providers are in the network, the status of your claims, etc.

    Ways to protect yourself from a phishing scam

    Below are some tips on how to safeguard your personal information from phishing scams and other fraudulent behavior:

    • Remember: LifeWise will never contact you to solicit your personal protected information
    • Do not provide your personal protected information to anyone who calls or emails you unrelated to an inquiry you made
    • Proceed with caution – do not make any decisions before investigating the details
    • Never email personal or financial information unless via our secure member site
    • Safeguard your member ID card at all times and do not give out your information contained on the card to anyone other than your doctor, hospital or pharmacy
    • Hang up on fake phone requests

    How to report phishing scams to us

    You can call us at any time to report suspicious activity:

    800-360-9535 (toll-free)