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.