Fraudulent activity within the health care industry is a serious issue – one that can cause a number of problems, the most serious of which being a compromise in quality of care. St. Charles County Ambulance District takes allegations of fraud very seriously, and provides an avenue for individuals to report fraud, waste or abuse within the District’s operations and programs.
Health care fraud is committed when someone intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits payable. that is a crime. Any person convicted of health care fraud faces imprisonment and substantial fines.
It is estimated that losses due to fraud add $100 billion to the annual cost of health care in the US. For most employers, fraud increases the cost of providing benefits to their employees, and therefore, their overall cost of doing business. That translates to higher premiums and out-of-pocket expenses, as well as reduced benefits or coverage.
How do I report suspected Fraud?
Internet: Use our Fraud & Compliance Contact Page
US Mail: Print a Suspected Fraud Reporting Form and mail to SCCAD Headquarters, attn: Fraud & Compliance Officer
What types of issues should I report?
A variety of situations may be considered fraudulent – particularly those with regard to billing (either to an insurance company, Medicare, Medicaid or a private individual) for services rendered by SCCAD.
Examples of health care member fraud include, but are not limited to:
- Abusing ambulance services for non-emergencies solely for a ride to the hospital
- Giving false information or that of another individual
- Using someone else’s insurance card
- Using an expired insurance card
- Identity theft
Examples of health care provider fraud include, but are not limited to:
- Altering claims or medical records to receive higher payment
- Billing for services that did not happen
- Upcoding; a practice in which a provider doesn’t bill the correct code, but one that will result in higher payment
- Misrepresenting the services rendered
What information do I need to provide when reporting suspected fraud?
Generally speaking, the more identifying information you provide regarding the suspect, victim and details of what occurred, the easier it is for SCCAD to conduct a thorough investigation. Our fraud reporting form clearly details the information we’d ideally like to have about an instance of suspected fraud.
May I remain anonymous?
Yes, however, please remember that your decision for anonymity may limit our ability to conduct an investigation.
Will my identity remain confidential?
We understand that in some cases, informants may believe that disclosure of their identity may compromise their personal safety. To the maximum extent allowed by law, we will only release your identity to those that have a need to know in order to conduct an appropriate investigation.
Will SCCAD update me on the status of the issue?
We cannot provide any information regarding what action we have taken on any allegation(s) of fraud reported to our office. Rest assured, however, that SCCAD takes these issues seriously, and will investigate each to the best of our ability.