Healthcare Fraud Prevention and Reporting
Healthcare fraud hurts everyone. In addition to higher premiums and increased out-of-pocket costs, healthcare fraud compromises health and safety, which can result in harm to patients, and undermines the public’s confidence in the healthcare system.
Sinai Chicago puts great effort to prevent healthcare fraud for its patients and encourages reporting to the proper authorities. Sinai Chicago partners with state and federal agencies to report, investigate and reduce the incidence of healthcare fraud.
Who to Contact for Information or with a Complaint
If you have any questions about this notice or any complaints, please contact:
Sinai Chicago
Attn: Compliance and Business Ethics Office
1500 South Fairfield
Chicago, IL 60608
Compliance Helpline: 1‐773‐257‐5424 or 1‐877‐435‐7559
What Is Healthcare Fraud?
Healthcare fraud is a federal crime under most criminal codes, consisting of intentional deceit for the purpose of illicit gains. Healthcare abuse is similar activity or behavior where there is intent to obtain an unlawful gain. Some examples of healthcare fraud and abuse include:
- Phantom claims for services or supplies that were never provided
- Using someone else’s medical insurance information to obtain services or supplies
- Falsifying signatures or medical records to support misrepresented services or supplies
- Unbundling services from a group to unlawfully increase medical payment
- Misrepresenting the location where services or supplies are provided
- Rendering medical care without a license
- Duplicate claim submissions
How to Protect Yourself from Healthcare Fraud
Although healthcare fraud is committed by a very small minority within the healthcare system, no one can assume it won’t happen to them. We encourage you to take these steps to avoid becoming a victim of healthcare fraud:
- After care, review your statement to verify accuracy.
- Ask your doctor to explain the reason for services.
- Report any discrepancies to your health insurance plan or payer.
- Beware of “free” medical services, as illicit entities use this lure to obtain information.
- Safeguard your insurance member ID card.
- Report instances where co-payments or deductibles are waived.
- Don’t give your insurance number to marketers or solicitors.
- Never sign a blank insurance form.
Reporting and important websites:
Commercial and Public Health Care Fraud (Federal Bureau of Investigation)
Medicare/Medicaid Health Care Fraud (Office of Inspector General, Department of Health and Human Services)
Federal Employee Health Care Fraud (U.S. Office of Personnel Management)
Mail Fraud (United States Postal Inspection Service)
Identity Fraud (Federal Trade Commission)
National Health Care Anti-Fraud Association – A public/private partnership for healthcare fraud
Casualty and Life Insurance Fraud (Coalition Against Insurance Fraud)