Fraud & Abuse
Protect yourself from scams and identity theft
Health care fraud affects all of us. It impacts the quality of health care. Aetna Better Health of Illinois is dedicated to fight fraud, abuse and waste through its Fraud Prevention Program. This program is designed to detect and eliminate health care fraud, abuse and waste.
What can you do?
Know what to look for. It can help you protect your identity and benefits. Be suspicious of:
- People trying to sell you health care items or services door-to-door or over the phone
- People who offer money or gifts for health care services
- Bills for services or equipment you didn't get
- Shipments of medical supplies you didn't order
- Someone using your ID card to get medical care, supplies or equipment
- People offering you free gifts or services in exchange for your ID number
- Falsifying timesheets for services not provided or only partially provided
- Incorrectly stating a diagnosis to get higher payments
- Performing unnecessary services to get higher payments
You can take steps to protect benefits and your identity
Know who you're sharing information with
Don't be afraid to ask questions if someone asks for your personal information. Never give out your Social Security number, health plan numbers, or banking information to anyone you don't know.
There are many different types of Fraud, Waste and Abuse
It’s important to be able to identify these issues and protect your identity and benefits.
Online theft of personal information
People may try to steal your personal or Medicare-Medicaid information online. They can harm you financially and may disrupt your benefits. It’s not always easy to distinguish an important email about your benefits from an online scam. An email may say there’s a problem with your account or ask for updated information to continue your coverage.
You can help support our mission to reduce and eliminate fraud in the health care industry by following a few simple guidelines:
- Be careful when providing your health care information, including your member identification number. Be cautious of "free" medical treatments where you are required to provide them with your health care information.
- Understand your benefit plan and what types of treatments, drugs, services, etc., are covered.
Many legitimate businesses use telemarketing. But criminals can also use live or recorded calls to try to steal your identity. Aetna won't call to ask for your bank account number, Social Security number, ID number or health plan ID number.
What you can do:
- Hang up on recorded messages that ask you to verify your personal information.
- Don't press any keys or numbers when prompted - even if it's to take your name off their list.
- Never give your personal information to someone you don't know.
Online pharmacy scams
Most online pharmacies aren't safe or legal. They might send you medicine that is tampered with, expired, or fake. They could use your personal information to steal your identity.
What you can do:
- Only order from online pharmacies in your health plan's pharmacy network.
- Don't click on links in emails or pop-up advertisements on the internet.
- Don't order from pharmacies outside of the United States.
- Report pharmacies that...
- Offer prescription drugs without a prescription.
- Won't accept your prescription insurance card as a form of payment.
Lab test fraud
Your doctor must order genetic tests for Aetna to cover them. Some labs try to offer a free test in order to get your Aetna information. They may try to steal your identity or submit a fraudulent bill.
What to do before you agree to genetic testing:
- Make sure your doctor ordered the test.
- Make sure the test is medically necessary and that we cover it.
Report concerns to us
If you see something suspicious or have questions pertaining to fraud, waste and abuse please contact our Special Investigations Unit by calling 1-866-670-6885.
You can also report your concerns to us anonymously using our online form below.