SIU Red Flags
If you suspect fraud — Call the SIU Hotline - 1 888-4KO-FRAUD
BE SUSPICIOUS IF SOMEONE SAYS:
- "I represent EmblemHealth" without a valid reason for calling.
- "The service/equipment is free."
- "I need your EmblemHealth ID number," or your Social Security number.
- "I will pay you if you give me/let me use your EmblemHealth number."
- "I will pay you to visit my office."
- "I know how to get EmblemHealth to pay for it."
- "EmblemHealth wants you to have this."
- "The more tests we provide the cheaper they are."
ALSO BE SUSPICIOUS IF SOMEONE:
- Routinely waives copayments without checking on your ability to pay.
- Advertises "free" consultations.
- Shows up at the front door or calls on the phone to market EmblemHealth related services or products.
- Bills EmblemHealth for services you don't recall receiving.
UNLAWFUL ACTIVITIES INCLUDE:
- Billing more than once for the same service or product.
- Misrepresenting the services rendered.
- Misrepresenting a diagnosis to justify payment for services.
- Misrepresenting the place of service.
- Altering EmblemHealth claim forms to get a higher payment.
- Falsifying documents.
- Soliciting, offering or receiving a kickback, bribe or rebate.
- Secretly agreeing to any arrangement among parties that will result in higher charges to EmblemHealth.