How to Identify Recipient Fraud

Fraud is a deliberate deception or misrepresentation that someone makes in order to receive benefits he or she does not deserve.

Most people are honest and hardworking. A few individuals try to game the system to receive money or benefits they don't deserve. They are making a mistake-it is a crime to commit insurance fraud, and people can lose their benefits for it, and be prosecuted.

Examples of fraudulent recipient activities include:

•	Loaning their health care identification card or other insurance card to another person
•	Using someone else's health care identification card
•	Forging or altering a prescription
•	Doctor shopping in order to obtain multiple prescriptions
•	Intentionally receiving unneeded services or supplies
•	Accepting cash or other bribes for receiving services
•	Re-selling items provided by government health programs
•	Deliberately giving incorrect information to receive benefits

Waste, Abuse and Fraud

  • Definitions of Waste, Abuse and Fraud

  • How to Identify Provider Fraud

  • How You Can Help Detect and Prevent Fraud