Help Protect Your Benefits
Turn up the heat on insurance fraud
We’re committed to protecting your benefits from insurance fraud and abuse. As a plan member, you can help.
Insurance fraud can take many forms, from backdating a disability claim to submitting a fictitious or inflated medical or dental claim. These and other forms of fraud raise the costs of benefits plans to your employer, and can put the benefits coverage you now enjoy at risk.
What is insurance fraud?
Insurance fraud is intentionally providing misinformation or withholding information to ensure the payment of a claim. Providing false claim documents or exaggerating services that were provided constitute fraud and can carry severe penalties.
Who commits insurance fraud?
Anyone who has access to your insurance information can submit fraudulent claims—for example, you or your family members, or doctors, dentists or other service providers.
What are the penalties?
Confirmed cases of fraud are documented, and can be reported to your plan sponsor if necessary. This can result in disciplinary or other action.
Fraud is a crime, and cases may also be reported to the police. Convictions for fraud can carry penalties ranging from restitution, where the person must pay back the funds plus legal fees and interest, to a criminal record and even jail time.
How does insurance fraud affect me?
Insurance fraud is often referred to as a hidden crime, but the costs are quite visible. Plan sponsors and plan members become the victims of insurance fraud through increasing premiums and the potential for reduced or lost plan benefits. By being involved in the solution, you can help manage benefit costs and protect your benefit plan.
What can I do?
You can help prevent fraud by being a responsible consumer. Be aware of who you give your benefits coverage information to, and what you sign. You are responsible for the accuracy of any claims submitted on your behalf, and of any information you provide to support your claim.
Be part of the solution
- Do not provide blank signed claim forms to a service provider to submit the claim later. These can be used to submit fraudulent claims in your name.
- Do not change a date on a claim or withhold information to ensure payment. If you need to know when you are covered for a particular benefit, contact us. Our customer service representatives can provide you with information on the coverage available under your plan.
- Be sure the claims you submit are for supplies and services that are medically necessary. Don't accept receipts for services or supplies you have not received.
- Be wary of any advice you receive on how to ensure a claim is paid. You are responsible for ensuring the claim information you submit is correct. Be sure to also provide any supporting documentation on your claim.
- Check the Explanation of Benefits (EOB) you receive from Great-West on your claim, especially when you have assigned your benefits to be paid directly to the provider. Did you submit that claim? Is the information correct? Is the charge in line with what you were told? Have extra items or services you have not received been included on the claim? If you have any questions about the information on your EOB, please contact Great-West immediately.
- Be wary of aggressive marketing programs—for example, where a provider offers you a gift for becoming a client or for soliciting other employees to become clients, or offers to refer you to another provider for a prescription.
- Watch for providers who charge 2 different fees—a higher fee for clients with insurance and a lower fee for those who do not have insurance.
- Shop around. Costs can vary significantly among suppliers and providers. While most of the cost may be covered by your plan, higher prices can mean higher overall costs for your plan and may lead to reduced benefits.
Reporting suspicious situations
If you discover a suspicious situation, but are not comfortable discussing it directly, Great-West offers 2 ways to report concerns:
These are confidential tip lines. You will not be traced and you will not be asked to provide any information that would identify you. If you wish to hear back from us on your concern, please leave information on how we can contact you.