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Report Fraud

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We look out for our members, and helping you get budget-friendly health care is part of our mission. One of the ways we keep your costs down is by working to stop fraud.

Fraud can have a big impact on costs. Why? Because when we pay claims that aren’t valid, it drives up the cost of care for everyone.

What is health care fraud?

If someone intentionally misrepresents themselves to get health care, services, or payments they aren’t entitled to, they’re committing health care fraud.

Health care fraud is not only unfair and harmful – it’s also a crime. Health care fraud includes:

Billing for care that wasn’t provided or for more expensive services than what someone got

Billing services the plan doesn’t cover as if it were covered

Writing prescriptions that aren’t needed

Selling prescriptions

Stealing someone else’s identity to get care or services covered Billing for care that wasn’t provided or for more expensive services than what someone got

How do we fight fraud?

Our Special Investigations Unit (SIU) protects you by investigating fraud. Former law enforcement professionals and investigators make up the team, and they’re skilled at analyzing claims.

SIU works with members, Shared Health Mississippi employees, different health plans and other stakeholders to find and stop fraud. In some cases, our team provides support to local, state and federal law enforcement officers in their efforts to prosecute crimes.

You can help us fight fraud.

You’re an important part of the fight against fraud. You can help us find fraud and stop it. Here’s how:

Look over any charges listed in your Benefit Summary. Let us know if it shows services you didn’t get.

Prevent identity theft by protecting your information. Keep your ID and insurance cards (like your Member ID card) in a safe place. It’s also good to destroy your old ID cards.

If you see something you think may be health care fraud, please let us know. You can report it to us by calling 1-800-832-9471. Or click here to complete our online form.

Protecting Your Information.

More and more people are reporting telemarketing fraud calls. Protecting yourself can be as easy as hanging up the phone. If someone calls you, don’t give information like your Social Security number, health insurance policy number or other personal information to anyone you don’t know. Be wary of offers that include free services or products. You can report the call to us at 1-800-832-9471.

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