Fraud Awareness
As a not for profit organisation HBF are committed to protecting the interests of our members whilst ensuring claims are paid quickly and efficiently. Unfortunately not all claims submitted to HBF are a true reflection on the services provided and not all actions taken by third parties are undertaken with good intentions.
Prevention and Detection
HBF’s Payment Integrity team utilise anomaly identification software and health experience to detect, investigate and sanction instances of fraud as appropriate. HBF has zero tolerance towards fraudulent behaviour.
What is fraud?
Fraud comes in all shapes and sizes but in all instances, it is the intent to gain by deception. Within health insurance this could include:
- Allowing someone else to use your HBF membership card
- Providing false documentation
- Being charged for services not provided
Provider Fraud
It is the responsibility of all providers to ensure that all records, invoices and claims submissions are correct and complete. Misrepresentation of services and alteration of invoices are common themes but also poor administrative techniques can lead to fraud by third parties including employees.
How can you help?
All the software and techniques in the world can’t replace people. It’s our members and providers who have the best opportunity to identify when something isn’t right. If you see something that doesn’t look right or become aware of suspicious activities, we’re here to help.
Contact us