what is fraud and inappropriate claiming?
Health insurance fraud and inappropriate claiming is where someone receives a benefit payment using false or misleading information.
All forms of fraud and inappropriate claiming increases the cost pressures on your health fund contributions.
You, as a member, can help in the detection and prevention of fraud and inappropriate claiming by:
- Not leaving your CBHS membership card with your provider (would you leave your credit card?).
- Checking your accounts/receipts before signing and leaving the providers practice, to make sure the services listed are correct.
- Reporting your lost, misplaced or stolen membership card to CBHS immediately.
A Benefit Statement is sent to members indicating benefits paid directly to providers on your behalf. Below is a checklist for reviewing your Benefit Statements.
- Did the persons listed on the statement receive the service or treatment?
- Are the numbers of services listed correct?
- Is the name of the provider listed on the statement the person who provided you with the service or treatment?
- Were any services listed not provided?
- Are any listed services actually quotes for services which were not in fact provided?
- For hospital admissions, is the number of days listed as private or shared accommodation correct?
- Are the admission and discharge dates correct?
- For medical claims, were you an admitted patient in a hospital?
Fraud and inappropriate claiming can originate from the providers practice, from persons listed on a membership or from a health fund. There are a number of ways that these acts occur and are not limited to:
- Incorrect recording of procedures to maximise payment by the provider.
- Collusion between members and providers to make false claims.
- Electronic or paper claims for services not rendered.
- Submitting altered receipts/claims.
- Allowing the use of your CBHS membership card to a person not listed on your membership.
If you know someone whom you suspect is making fraudulent claims against CBHS, have any concerns regarding inappropriate claiming practices, or if the details on your Benefit Statement are incorrect, please contact CBHS directly on 02 9843 7696, email or call our Member Care Centre.
Fraud is a criminal offence and inappropriate claiming will not be tolerated by CBHS. Anyone found to be committing fraud or submitting inappropriate claims, risk legal action and or the termination of membership with CBHS.
FRAUD & INAPPROPRIATE CLAIMS COSTS YOU!