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What to look out for:
• Billing for services that were never provided.
• Billing for medically unnecessary services.
• Duplicate submission of claims for the same service or supply.
• Misrepresenting the service provided through:
o Changing the service to a more expensive type of service.
o Reporting the wrong diagnosis or service.
• Misrepresenting the dates, location or provider of the service.
• Soliciting, offering, or receiving a kick-back.
• Waiving or reducing deductibles/copayments.
• Intentionally omitting other coverage or supporting false injury claims for higher reimbursement levels.
• Shaping the diagnosis, treatment, and/or billing coding to fit plan reimbursement provisions, for example:
o Plastic surgery “nose job’ billed as a deviated septum.
o Altering the diagnosis code order for greater benefit.
o Ordering tests inconsistent with diagnosis indicated.
o Extensive testing for multiple family members.
If you identify any possible fraud or abuse in the claims submitted for services rendered for you or your eligible dependents, please notify the Trust Fund Office immediately.
Click HERE to access your claims information.