Anti-Fraud Policy

Medical insurance information can be exploited in ways that increase costs and decrease confidence in the healthcare system. If you know of or suspect health insurance fraud, please report it.

What is Healthcare Fraud and Abuse?

Healthcare fraud takes place when a clinician or patient intentionally submits (or causes someone else to submit) false or misleading information for use in determining the amount of healthcare benefits payable. Healthcare abuse is similar to healthcare fraud, but where intent cannot be established.

Some examples of healthcare fraud and abuse are:

  • Billing for services not actually performed.
  • Falsifying a diagnosis to justify unnecessary tests or procedures.
  • Misrepresenting procedures to obtain payment for non-covered services.
  • Upcoding – billing for a more expensive service than the one performed.
  • Unbundling – billing separately for services typically billed together.
  • Accepting kickbacks for patient referrals.
  • Waiving patient fees and over-billing the insurance carrier or benefit plan.
  • Billing more than the deductible, co-pay and coinsurance amounts.

Some examples of patient healthcare fraud are:

  • Visiting numerous doctors (“doctor shopping”) to get multiple prescriptions for the same drug.
  • Filing claims for services or medications not received.
  • Forging or altering bills or receipts.
  • Using someone else’s coverage or insurance card.
  • Allowing someone else to use your insurance card.

Protecting Yourself

Medical Identity Theft is a fast-growing crime in which a thief uses a person’s name and social security or health insurance number to get medical treatment, or charge insurance companies for phony services. Victims can be left with huge bills for services they never received, along with legal, medical, and insurance-fraud issues that can take years to untangle. Even more, experts say that anyone with insurance is a potential victim of Medical Identity Theft. We encourage you to follow these general guidelines to safeguard yourself from medical identify theft and/or fraud.

  • After care, review your statement and Explanation of Benefits for incorrectly billed services or date of service and any false or inaccurate statements.
  • Beware of “free” medical services, as illicit entities may use this lure to obtain information.
  • Guard your insurance card and health insurance ID number as you would your credit card information.
  • Don’t give your insurance number to marketers or solicitors.
  • Never sign a blank insurance form.
  • Shred all old insurance cards and statements or redact private information if you must keep them.
  • You are entitled to a copy of your medical records. Review these records periodically for inaccuracies.

Report Suspected Fraud

You may use any of the contact options listed below to report suspected fraud or abusive billing practices to Kinwell. You may report suspicions or allegations of Fraud or Abuse anonymously.

All information remains confidential and protected.

Complete a Healthcare Fraud and Abuse Complaint Form

Email us at Compliance@KinwellHealth.com.

Call and leave a message on our Hotline at 833-910-4400

Additional Resources

Washington State Office of the Insurance Commissioner

File a Complaint | Washington State