Scott & White Health Plan

Fight Healthcare Fraud

There is no shortage of willing participants among providers, pharmacies, pharmacists and yes patients. Criminals are smart and agile making it challenging to catch them. They are often aware they are being watched and the stakes are high. The entire healthcare community has a role to play in anti-fraud efforts. Scott and White Health Plan is committed to making your member experience the best one possible. This is why we are asking for your partnership in helping us to help you. Please pledge to commit yourself to read all EOB statements and report any suspicious activity to Scott and White Health Plan by calling 1-888-800-1096. We know that together we can take a bite out of Healthcare fraud.

Examples of Healthcare Fraud

After surgery, Dr. Dan tells John Doe that he will need a breathing machine to assist in his recovery process and told the member that he will be contacted by ABC Company who will deliver the medical equipment.  The physician informs ABC Company that John Doe needs a breathing machine.  John Doe notices on his EOB statement that Medicare paid a total of $2,970.00 to ABC Company for a breathing machine and a wheelchair.  ABC Company fraudulently included a wheelchair to the claim for John Doe to Medicare.

Jane Doe goes to a Chiropractor and complains that she is having back pains.  The Chiropractor examines Jane Doe's back by having her bend over and touch her toes.  He then prescribes 2 muscle relaxers and tells her nothing is wrong.  A couple of months later, Jane Doe opens an EOB statement informing her that Medicare paid the chiropractor $1,500.00 for 2 physical therapy sessions.  The Chiropractor fraudulently submitted a claim to Medicare for services never rendered.