A Healthy CollaborationSM

Medicare Fraud, Waste and Abuse

The second largest white-collar crime in the U.S. is insurance fraud. It affects everyone by making insurance premiums more expensive. PrescribaRx is helping the fight against health care fraud by increasing awareness among our members and employees.

We fully support the prosecution of health care providers, agents, policy owners, employees, and other groups or individuals who defraud the Medicare system and insurance companies. We aggressively investigate reports of fraud and cooperate with law enforcement officials in their prosecution efforts.

Examples of Medicare Plan Fraud
  • Disability Insurance Fraud - misrepresentation of a disability or a pre-existing medical condition; it may also involve a claimant having secondary employment while he or she collects disability payments.
  • Health Insurance Fraud - altered or fabricated medical bills, and excessive or unnecessary treatment.
  • Provider Fraud - billing for services not rendered, or falsifying claim forms for claimants to receive benefits to which they are not entitled.
  • Life Insurance Fraud - an insured person who misrepresents his or her medical history or identity at the time of application or creates false claims.
  • Uninvited door-to-door solicitation- this is when an insurance agent comes to your door uninvited and tries to sell you a Medicare medical or drug plan or other Medicare product.
  • Unfamiliar drugs on your Explanation of Benefits- if you see drugs listed on your Explanation of Benefits that you're not taking, someone could be filling prescriptions using your name and drug coverage.
  • Short-fills on prescription drugs - this is when a pharmacist gives you fewer pills than what your doctor may have prescribed.

Help Fight Fraud
When someone commits fraud against Medicare, it affects everyone. If you suspect someone of committing insurance fraud against Today's Options® PPO or think you may be a victim, please report the suspicious activity.

Call the Fraud, Waste and Abuse Hotline at 1-800-853-0186. Or e-mail [email protected]. All calls and e-mails are confidential and may be anonymous.

For more information about insurance fraud, visit www.insurancefraud.org.

M0018_TOPPO_209 Pending CMS Approval Last updated: 4/1/2022

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