You Can Make a Difference – Report Suspected Fraud

Health care fraud significantly adds to the rising cost of health insurance. Not only does it raise the premiums employers and members pay, but it lowers the amount of money on hand to pay honest doctors. Health Net is committed to fighting fraud waste and abuse. You can help us!

How to Report

Our Special Investigations Unit can be used as a resource to Health Net employees, members and doctors. It can also be used by Health Net delegates. Health Net's Fraud Hotline and Integrity Hotline are open 24/7. Callers may choose to remain unknown.

What to include in your report:

1. Unless you choose to remain anonymous*, please be sure to include your:
   • full name
   • phone number
   • address, and
   • email address
2. Explain the nature, scope and time frame of the activity in question.
3. Explain how you are aware of the alleged activity.
4. Specify if you know of any potential witnesses to the activity.
5. Provide any documents or other physical evidence in your possession.

*If you are submitting your report anonymously, please take care to withhold personally identifiable information.

Fraud Awareness Tips

The following links explain common fraud schemes that could impact members.

• Genetic Testing (PDF)
• Charging for Prescriptions (PDF)
• Open Enrollment Identity Theft (PDF)
• Before You Change Coverage (PDF)
• Email Scams (PDF)
• Prescription Drug Abuse and Misuse (PDF)
• Discount Prescription Drug Card Scams (PDF)
• Telemarketing Scams (PDF)
• Risks Associated with Online Pharmacies (PDF)
• Home Health Fraud (PDF)
• Medical Transportation Fraud (PDF)
• Health Insurance Marketplace Fraud (PDF)

• Questioning Free Medical Supplies - English (PDF) 
• Questioning Free Medical Supplies - Spanish (PDF)

• Services Not Provided - English  (PDF)
• Services Not Provided - Spanish (PDF)

• Identity Theft Prevention Tips - English (PDF) 
• Identity Theft Prevention Tips - Spanish (PDF)

• Other Fraud Considerations - English (PDF) 
• Other Fraud Considerations - Spanish (PDF)

The following links address other important matters.

• Prescriber Enrollment (PDF)
• How to Dispose of Medicine Properly (PDF)

Samples of Fraud and Non-Compliance

Consumer Health Care Fraud

• Filing claims for services or medications not received
• Forging or altering bills or receipts
• Using someone else's coverage or insurance card

Provider Health Care Fraud

• Billing for services not actually performed
• Falsifying a patient's diagnosis to justify tests, surgeries or other procedures that aren't medically necessary
• Upcoding – billing for a more costly service than the one actually performed

Non-compliance

• Theft or unauthorized removal of company/business documents from the premises
• Falsifying or tampering with company documents or records
• Violations of Health Net's Code of Conduct
• Insubordination, dishonesty, gross carelessness/negligence of duties