“It is imperative that we are diligent in our campaign against the misuse of health insurance dollars, thus KPS is going forth with great effort to ensure we are thorough in our endeavor,” said Elizabeth Gilje, KPS Health Plans President and CEO. “The rising costs created by these crimes not only affect the consumer, but the health care system in general.”

Health insurance abuse and fraud can include such things as overpayment of claims or services, as well as identity theft. On average, the typical Washington household pays more than $200 each year in additional insurance premiums that can be directly attributed to insurance scams and fraud, according to the Washington State Office of the Insurance Commissioner. Figures from the National Health Care Antifraud Association (NCHAA) show this one type of crime costs American consumers as much as $1 out of every $7 spent on health care.

KPS recommends treating insurance cards as though they were credit cards. Always read benefit booklets and explanation of benefits (EOB) statements or any other paperwork received from your health insurance company or medical provider. Be wary of any “free” medical treatment, as these are usually scams. And, never provide your health insurance, social security or other personal information to any stranger who calls or solicits you via the Internet.

The KPS Special Investigative Unit scrutinizes all potential cases of medical and pharmacy fraud or abuse. A special hotline and website have been set up to encourage members, providers, or others to report suspicious or known activities. The confidential hotline is 800-552-7114 ext. 6891, and the web page can be found at www.kpshealthplans.com/stopfraud/kpsfraudinfo.html, where a confidential electronic form can be submitted.