Fraud and abuse takes place everyday and may go unnoticed. IBA Health Plans has developed a Fraud and Abuse program to identify and detect Fraud and Abuse. If you suspect that IBA Health Plans, a health care professional or someone you know has been a victim of health care fraud, it is important to report your concerns.

What is Fraud and Abuse?

Fraud is when someone lies or does not tell the entire truth, and then they benefit from it. Some types of "fraud" are:

Being billed for services when no services were provided to you.
A provider discharging members from their care because of the member's health.
Giving or loaning your ID card to someone else so they can get medical or pharmacy services
Someone other than you using your ID card
Changing a prescription
Giving false information to get medical or pharmacy services

Abuse is when actions are done that cost IBA Health Plans extra money. Some types of "abuse" are:

Going to the emergency room for non-emergency medical services
Hostile or rude behavior in a doctor's office, hospital or pharmacy

What can I do?

Report suspicious billing.

For claim questions, billing errors, or provider disputes please contact an IBA customer service representative at the phone number listed on your medical identification card.
Review your policy and benefit statements.

Review your policy, explanation of benefit (EOB) statements and any other paperwork you receive related to your health care coverage. Make sure you received the treatments for which your health plan was charged, and question suspicious expenses.
Beware of "free" offers, including waiver of co-pay.

Offers of "free" services are often fraud schemes designed to bill you and your health plan illegally for thousands of dollars of treatments you never received. Do not give your policy number in exchange for getting a "free" consultation.
Protect your health plan ID card like your credit card.

In the wrong hands, a health plan ID card is a license to steal. Don't give policy numbers to door-to-door salespeople or telephone solicitors. Never give your card to a friend to use for medical services.

If you have questions about fraud and abuse, or to report suspected fraud or abuse, please call the IBA Customer Service Department at the number indicated on your ID card. You can write to us at:

IBA Health Plans ATTN: Compliance Department
106 Farmers Alley, Suite 300, P.O. Box 51100
Kalamazoo, MI 49005-1100

You can always remain anonymous.

View Code of Federal Regulations (CFR): 42 CFR 455.2

Other Resources:
Centers for Medicaire & Medicaid Services
Medicaid Fraud & Patient Abuse Complaint Filing Information
Fraud & Abuse Reporting Requirements

Updated 9/1/06