how do report health insurance fraud?

Question

A co-worker of mine has had a tummy tuck paid fully by the our health insurance company and she was suppose to have only 4 weeks off. Now she gets 2 months off becuase her doctor won't relase her. I think she's suppose to stay home durring this time but last week i saw her at theme park and concert. Is there a number i can call to report health insurance fraud?

Answer 1

You can report ANY kind of insurance fraud, to your state insurance department. Many states have a place where you can report it online.

Answer 2

The fact that the insuror paid for a tummy tuck sends up a red flag, as this would most likely be considered cosmetic surgery, and something not covered. If it was infact covered, I suspect that your company is self-insured, allowing for this type of claim.
In any case, most insurors have a phone number to report fraud anonymously.

Answer 3

The rebate check goes to the POLICYHOLDER. Not the subscriber. So if this was a group plan, the rebate goes back to the employer. If it was NOT a group plan, it goes back to the policyholder. You'd file your complaint with your state insurance commisisoner. You'll have to send in the policy declarations page, to prove that you are the policy holder (and not just an employee under the employer's policy), and that you are entitled to the refund.

Answer 4

Your state's insurance board or insurance commissioner - and you can drop a dime anonymously.