Anthem believes the vast majority of providers and groups are honest and share our interest in deterring health insurance fraud. However, a relatively small group of people may take advantage of Anthem and our policyholders. When someone takes advantage of Anthem, that person also takes advantage of you.
That's why Anthem has a Special Investigations Unit to detect, analyze, investigate and refer for prosecution any alleged fraudulent practices by providers, members, groups, brokers and Anthem associates. Our Special Investigations Unit consists of investigators and auditors from Indiana, Kentucky, Ohio, Connecticut, Maine, New Hampshire and Colorado/Nevada. Anthem investigators have various backgrounds which includes law enforcement and claims administration.
Anthem's Special Investigations Unit mission is "To protect the integrity of the healthcare system we serve through the detection and prosecution of those parties responsible for fraud against Anthem Inc. and its affiliated companies."
What is Healthcare Fraud?
Fraud is when someone knowingly and willfully lies in order to get benefits or money from Anthem. It happens when a claim submitted to Anthem includes intentional misrepresentation of services and/or supplies. The following are a few examples of healthcare fraud:
| billing for services and/or supplies that were not furnished|
| altering claim forms to receive a higher reimbursement|
| soliciting, offering or receiving a kickback, bribe or rebate (e.g. paying for patient referrals in exchange for ordering of tests, services or equipment)|
| altered prescriptions or medical bills |
How to Report Suspected Fraud?
To report suspected fraud, please contact the Special Investigations Unit in your area. If your area is not represented please contact any of the following offices to receive assistance.
| Connecticut 800-258-3258 |
| Maine 800-285-7424 |
| New Hampshire 800-203-3738 |
Health Care & Fraud Related Links