Fraud Waste and Abuse
Did you know?
Health care fraud significantly adds to the rising cost of health insurance. Not only does it raise the premiums employers and members pay, but it lowers the amount of money on hand to pay honest doctors. Health Net is committed to fighting fraud waste and abuse. You can help us!
How to report
Our Special Investigations Unit can be used as a resource to Health Net employees, members and doctors. It can also be used by Health Net delegates. Health Net's Fraud Hotline and Integrity Hotline are open 24/7. Callers may choose to remain unknown.
What to include in your report:
- Unless you choose to remain anonymous please provide your:
- Phone number
- Email address
- Explain the nature, scope and time frame of the event in question.
- Explain how you are aware of the alleged infraction.
- Let us know of others who may have also seen the infraction.
- Provide any forms, records, or other solid proof you may have.
Fraud awareness tips
These links explain common fraud schemes that could impact members.
- Genetic Testing (PDF)
- Charging for Prescriptions (PDF)
- Open Enrollment Identity Theft (PDF)
- Before You Change Coverage (PDF)
- Email Scams (PDF)
- Prescription Drug Abuse and Misuse (PDF)
- Discount Prescription Drug Card Scams (PDF)
- Telemarketing Scams (PDF)
- Risks Associated with Online Pharmacies (PDF)
- Home Health Fraud (PDF)
- Medical Transportation Fraud (PDF)
- Health Insurance Marketplace Fraud (PDF)
- Questioning Free Medical Supplies - English (PDF)
- Questioning Free Medical Supplies - Spanish (PDF)
- Services Not Provided - English (PDF)
- Services Not Provided - Spanish (PDF)
- Identity Theft Prevention Tips - English (PDF)
- Identity Theft Prevention Tips - Spanish (PDF)
- Other Fraud Considerations - English (PDF)
- Other Fraud Considerations - Spanish (PDF)
The links below address other important matters.
Samples of fraud and non-compliance
Consumer health care fraud:
- Filing claims for services or medications not received.
- Forging or changing bills or receipts.
- Using someone else's coverage or insurance card.
Provider health care fraud:
- Billing for services not given.
- Giving a false diagnosis to:
- Prove tests were needed.
- Perform surgeries.
- Perform other services that weren't needed.
- Upcoding. Billing for a more costly service than the one given.
- Theft of company and/or business documents.
- Changing company documents or records.
- Breaching Health Net's Code of Conduct.
- Refusing to follow rules.
- Slacking of duties.