SID Saves the Day

1. A provider exchanges money and/or other things of value for the referral of patients for services, which often are not medically necessary or have no validity or diagnostic value. The provider may attempt to disguise the kickbacks through leasing agreements and false professional affiliations.
4. Vice President, Special Investigations Department
5. Review your Explanation of ________ (EOBs) to detect red flags of fraud or medical procedures that did not happen.
9. Up- ___ is when a provider bills the health insurance company for a more expensive service, supply or piece of equipment than was actually provided.
10. Concerns can be reported to the SID Fraud____ at 800-543-0867.

2. Special ____ Department investigates allegations of both internal and external healthcare insurance fraud.
3. Un-____ is when a provider bills separately for procedures that are considered part of a single procedure or included as part of a global fee.
6. A provider commits duplicate _____ when he submits two or more claims for the same procedure, changing details such as the date of service in an attempt to get the insurance company to pay for the same procedure multiple times.
7. Using false identification in order to gain employment and health insurance coverage is called identity ____.
8. Routinely waiving the _____ is misrepresenting the true cost of services resulting in inaccurate claims.