Anti-Fraud and Abuse

TakeCare has created a Anti-Fraud Hotline to specifically address health care fraud, a national problem, prevalent in federal and state (and territories) as well as private insurance programs. Health care fraud occurs when a person or business intentionally misrepresents facts to receive reimbursement for health care services or supplies. Health care fraud is estimated to cost billions of dollars each year.* 
 

If you suspect fraudulent actions and abuse within your plan or our network, please call (671) 649-5484 or email fraudsolutions@takecareasia.com.

 

TakeCare has invested in programs to address healthcare fraud.

  • TakeCare has its own investigative unit that actively pursues fraudulent activities and the recovery of monies lost to fraudulent or abusive activities.
  • Computer and software technology analyzes thousands of claims for patterns of suspicious billing activity.
  • If a potential fraud case is identified, TakeCare reports the case to regulatory agencies, appropriate law enforcement agencies and licensing boards.

 

In order to maintain the affordability of health care, it is important that all of our members take the following precautionary steps against fraud and abuse.

  • Never give your member number or plan identification number over the telephone or to people you do not know, except for your health care providers, authorized health benefits plan, or Human Resources representative.
  • Periodically review your claims history through the MyTakeCare member portal for accuracy to ensure we have not been billed for services that you did not receive.
  • Do not ask your doctor to make false entries on certificates, bills or records in order to get us to pay for an item or service.
  • If you suspect that a provider has charged you for services you did not receive, billed you twice for the same service, or misrepresented any information, call the provider and ask for an explanation. There may be an error. If the provider does not resolve matter, call us at (671) 649-5484 or email fraudsolutions@takecareasia.com and explain the situation.
  • Make sure that your dependents are eligible to be covered under your plan. Do not cover a former spouse when a divorce decree or annulment is final or child over 26 years of age (unless he/she is disabled and incapable of self-support prior to age 26).
  • Notify us of apparent alterations or forgeries of prescriptions. 

 

Fraud can result in improper payments, but fraud is not the only cause of wasteful spending in federal and privately operated health care programs. Payments for unnecessary medical services, for claims with insufficient documentation, for ineligible patients and to ineligible providers, are examples of improper expenditures that squander taxpayer dollars and drive up health care costs.

 

*Reference: 
U.S. Department of Health & Human Services, www.hhs.gov