Mutual of Omaha Rx (hereinafter, the Plan) has ways to fight fraud, waste, and abuse.
The National Health Care Anti-Fraud Association (NHCAA) website reports that the United States spends more than $2.5 trillion on health care every year and estimates that tens of billions of dollars are lost to health care fraud, waste and abuse. Loss impacts patients, taxpayers and the government because it leads to higher health care costs, insurance premiums and taxes. Health care fraud often hurts patients who may receive unnecessary or unsafe health care procedures or who may be the victims of identity theft. Health care fraud is not a victimless crime and can have long-lasting devastating effects.
Health care fraud is knowingly and willingly 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 or any health care benefit, program.
According to the NHCAA, whether you have health insurance through your employer or you purchase your own insurance policy, health care fraud causes higher premiums and out-of-pocket expenses for patients and reduces benefits or coverage.
Health care fraud also has a human face to it. These are people who may have been taken advantage or subjected to unnecessary or dangerous medical procedures. A patient’s medical records may be stolen and used to fraudulently bill insurance companies; this may affect a patient’s medical history.
The Plan CANNOT ask for member identification numbers (e.g. bank account numbers, credit card number, Health Insurance Claim Number "HICN") EXCEPT as required to verify membership, determine enrollment eligibility or process an enrollment request). The Plan will NEVER ask for your Social Security Number.
Phishing is a type of theft used by fraudsters to lure people into a false sense of security with the intent to steal a person's private information by phone calls, emails or copy-cat websites.
Identity theft happens when someone steals a person's information and uses it without his or her permission or knowledge. Medical identity thieves may use a person's name and personal information such as his or her health insurance number to make doctor's appointments, obtain prescription drugs, and file claims with his or her insurance company. This may affect the person's health and medical information and can potentially lead to misdiagnosis, unnecessary treatments, or incorrect prescription of medication. There are many ways an identity thief can obtain a person's health information, such as: paying for it, offering free services, supplying food or gifts, or providing free "health screenings."
The Office of Inspector General of the U.S. Department of Health and Human Services website provides the following suggestions to protect yourself against fraud:
The Plan is committed to fighting health care fraud, waste, and abuse.
We have a dedicated staff whose mission is to protect our policyholders, providers, employees, other related parties, and the Medicare Trust Fund by administering a plan to prevent and detect fraud, waste, and abuse. The staff works to investigate all allegations, correct offenses, recover lost funds, and will partner with Federal and state agencies to prosecute violators to the fullest extent of the law.
Here are some simple measures to protect yourself and help the fight against health care fraud:
If you suspect someone of committing insurance fraud against the Plan or think you may be a victim, please report immediately the suspicious activity to the Compliance Department:
Fraud, Waste, and Abuse Hotline – 866-898-2898
Medicare Compliance Department
3300 Mutual of Omaha Plaza
Omaha, NE 68175
All communications are confidential and may be anonymous.