Report Health Care Fraud
GEHA is committed to fighting health care fraud, waste and abuse, and helping you get the best value for your health care dollars. GEHA partners with local, state and federal agencies to report and investigate health care fraud.
What is health care fraud, waste and abuse?
Tips to Protect Yourself from Fraud
|Don't assume it will not happen to you. GEHA encourages our members to take the following steps:
- Review you explanation of benefits (EOB) to make sure you received the services indicated.
- Be careful with providers that refer to alternative treatments.
- Never sign blank insurance forms.
- Beware of free services.
- Do not give your insurance card number to marketers.
- Fraud is generally defined as knowingly and willfully executing, or attempting 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. (18 U.S.C. § 1347)
- Waste is overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the health care system, including the medicare and medicaid programs. It is not generally considered to be caused by criminally negligent actions, but by the misuse of resources.
- Abuse payment for items or services when there is no legal entitlement to that payment and the individual or entity has not knowingly and/or intentionally misrepresented facts to obtain payment.
GEHA works with local, state and federal agencies to report and investigate health care fraud. We encourage our members to report incidents with our partners.