Tips for Members to Prevent Health Care Fraud

Reducing health care fraud is a joint effort between Health Care Service Corporation (HCSC), its providers and its plan members.

Here are some ways our members can help fight health care fraud:

  • Understand what their plan covers.
  • Review all Explanation of Benefits (EOB) statements. Members should make sure they had the medical exams, tests and treatments with the provider shown on the EOB.
  • Understand what they are responsible to pay – know if the plan requires them to pay a deductible or copay.
  • Guard their member ID card, Social Security Number and other personal information. Call as soon as possible if their card or insurance information is lost or stolen.
  • Sign and date only one claim form per office visit.
  • Never lend their member ID card to someone else.
  • Don't give out their information if medical services or equipment are offered as "free." Be sure they understand what is "free." Also find out what they will be charged.
  • Before having a medical test or treatment, members should ask their doctors exactly what is needed and why. If in doubt, get a second opinion from another doctor.
  • Monitor what prescription drugs they use. Make sure the drugs billed to their health plan are correct.
  • Be aware of phony sales pitches over the phone. Do not disclose insurance or personal information.

Learn how to report fraud

Last Updated: March 18, 2021