Protecting Yourself from Health Insurance Fraud in Utah

Health insurance fraud is an unfortunate reality that can affect individuals and families in Utah. Understanding how to protect yourself from becoming a victim is crucial. Here are some effective strategies to keep in mind.

1. Understand Your Policy
Familiarize yourself with your health insurance policy, including what services are covered and the procedures for filing claims. This knowledge will help you identify any discrepancies in billing or claims made.

2. Review Medical Bills and Explanations of Benefits
Always review your medical bills and the Explanation of Benefits (EOB) statements you receive from your insurance provider. Look for charges for services you did not receive or billing for procedures that seem inflated or incorrect.

3. Be Cautious with Personal Information
Protect your personal and insurance information diligently. Never share your insurance card or sensitive details with anyone unless it’s absolutely necessary. Be wary of unsolicited calls or emails asking for personal information.

4. Verify Healthcare Providers
Ensure that the doctors, clinics, and hospitals you visit are licensed and accredited. Utilize resources like the Utah Division of Occupational and Professional Licensing to verify practitioners and check their backgrounds.

5. Educate Yourself on Common Fraud Schemes
Stay informed about common health insurance fraud schemes, such as billing for non-existent services, kickbacks for referrals, and upcoding (billing for a more expensive service than what was provided). Awareness can help you recognize and avoid these tactics.

6. Report Suspicious Activity
If you suspect fraud, report it immediately. In Utah, you can contact the Utah Division of Insurance or the National Health Care Anti-Fraud Association. Providing details can help prevent further fraud and protect others in the community.

7. Use Fraud Alerts and Identity Theft Protection Services
Consider enrolling in identity theft protection services that monitor your personal information and alert you to unusual activity related to your health insurance. These services can offer an extra layer of security.

8. Be Wary of "Free" Services
Be cautious of offers that seem too good to be true, such as free medical services or “no out-of-pocket” expenses. These can be red flags for fraudulent activities aimed at exploiting unsuspecting individuals.

By taking proactive steps, you can significantly reduce your risk of becoming a victim of health insurance fraud in Utah. Staying informed and vigilant plays a key role in protecting your health and financial well-being.