Fraud occurs when a dishonest member or provider lies on an application or claim
form with the intention of receiving a payment from Health Advantage to which
they are not entitled.
As stated in the Health Insurance Portability and Accountability Act (HIPAA) of
1996 (18USC, Ch. 63, Sec 1347):
Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice
to defraud any health-care benefit program; or to obtain, by means of false or fraudulent
pretenses, representations, or promises, any of the money or property owned by,
or under the custody or control of, any health-care benefit program, in connection
with the delivery of or payment for health-care services, shall be fined under this
title or imprisoned not more than 10 years or both.
Fraud and abuse is estimated to account for between 3 and 10 percent of the annual
expenditures for health-care in the United States.
Health-care fraud is both a state and federal offense. As stated in the HIPAA Act
of 1996: (18USC, Ch. 63, Sec 1347), a dishonest provider or member is subject to
fines or imprisonment of not more than 10 years or both. Making false or misleading
statements on an application carries a maximum five-year sentence.
Read your explanation of benefits (EOB) carefully. The EOB is your notification
that Health Advantage has paid a claim under your health-care benefits plan.
Call the Fraud Hotline at 1-800-372-8321 any time day or night. All tips are kept
The detection, prevention and elimination of fraud, abuse and over-utilization are
essential to maintaining a health-care system that is affordable for everyone now
and in the future.
We aggressively investigate and pursue the prosecution of the perpetrators of health-care
fraud, abuse and over-utilization, including providers of medical and other related
health services, agents, members and others.
We actively cooperate with criminal investigations conducted by federal, state and
local authorities, encourage education and conduct awareness programs to alert our
employees, members and the general public to potential fraud or abuse.
Health Advantage is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties in Arkansas. Copyright © 2002-2017 HMO Partners, Inc.