Fraud Awareness
As a not-for-profit health fund, Mildura Health Fund are committed to protecting the interests of our members. Unfortunately, not all claims submitted to Mildura Health Fund are a true reflection on the services provided and not all actions taken by third parties are undertaken with good intentions.
What is fraud?
Fraud comes in all shapes and sizes, but in all instances it is the intent to gain by deception. With health insurance this could include:
Member fraud can mean:
- Making a claim for goods or services that haven’t been provided.
- Claiming a benefit you’re not entitled to.
- Using a fake name to create a membership or to access claim benefits.
Provider fraud can mean:
- Invoicing for different item numbers for financial gain.
- Charging members for services that aren’t clinically necessary.
- Claiming benefits for services provided by another provider.
- Claiming for goods or services that weren’t provided.
Provider Fraud
It is the responsibility of all providers to ensure that all records, invoices and claims submissions are correct and complete. Misrepresentation of services and alterations of invoices are common themes, but also poor administrative techniques can lead to fraud by third parties including employees.
How can you help?
Our skilled team are experienced in detecting fraudulent behaviour, however our members and providers have the best opportunity to identify when something isn’t right. If you see something that doesn’t look right or become aware of suspicious activity, we’re here to help.
How can members help?
- Keep your membership card safe and your information confidential.
- Check that you have been billed correctly and for the right services.
- Tell us immediately if you see anything suspicious in your claim’s history.
- Make a report to tell us about anything you think is suspicious.
How can providers help?
- Make sure you’re using the right service codes on every claim.
- Let us know if anyone tries to make improper claims for benefits.
- Remember that you’re personally responsible for claim that use your provider number.
- Properly train staff in making claims and using your provider number.
Make a report to tell us about suspicious behaviour.
We know that making a report can feel a bit scary, but you’re doing the right thing for all of our members. If confidentiality is a concern, you can remain anonymous. The more you can tell us, the more likely we’ll be able to act on your information.
