False

Fraud, Waste and Abuse


InHealth has a program designed to handle cases of health care fraud, waste and abuse. Fraud can be committed by providers or members. We monitor and take action on any member or provider fraud, waste and abuse. Some examples are:

Provider Fraud, Waste and Abuse:
  • Prescribing drugs, equipment or services that are not medically necessary
  • Scheduling more frequent return visits than are medically necessary
  • Billing for tests or services not provided to you
  • Billing for more expensive services than provided
Member Fraud, Waste and Abuse:
  • Sharing your InHealth ID card with another person
  • Selling prescribed drugs or other medical equipment paid for by InHealth to others
  • Forging a doctor’s signature on prescriptions
  • Providing inaccurate symptoms and other information to providers to get
If you suspect fraud, waste or abuse
If you think a doctor or an InHealth member is committing fraud, waste or abuse, you can report your concerns to us by:
  • Calling our Compliance Hotline at 866-907-9204
  • Visiting our website at www.inhealthohio.org and reporting your concern through the Compliance Internal Messaging System;
    http://www.inhealthohio.org/fraud-waste-abuse-form
  • Sending us an email at fraud@inhealthohio.org; or
  • Sending us a letter addressed to:
    InHealth Mutual
    Attn: Compliance Officer
    501 West Schrock Road
    Suite 310
    Westerville, OH 43081
  • Mailing a Fraud Complaint with the Ohio Department of Insurance at:
    Ohio Department of Insurance, Fraud Division
    50 W. Town St., 3rd Fl.
    Suite 300
    Columbus, OH 43215
  • Calling the Ohio Department of Insurance Fraud Hotline at 1-800-686-1527; or
  • Filing a Fraud Complaint online at www.insurance.ohio.gov

In addition to reported allegations of fraud, waste and abuse, InHealth reviews medical and pharmacy claims data, reviews medical records, interviews members and providers, and works with state and federal law enforcement to identify and prevent fraud. If fraud, waste or abuse is identified, the InHealth Compliance Officer investigates and takes appropriate corrective action. Corrective actions may include, but are not limited to, dollar recovery, education and training, contract termination, disciplinary actions, law enforcement referral, Corrective Action Plans, and legal actions. All identified fraud, waste or abuse is reported to the appropriate government agencies. In circumstances where additional expertise is need, InHealth will contract with a Special Investigations individual or agency to assist the Compliance Officer with investigations.




Fraud, Waste and Abuse


InHealth has a program designed to handle cases of health care fraud, waste and abuse. Fraud can be committed by providers or members. We monitor and take action on any member or provider fraud, waste and abuse. Some examples are:

Provider Fraud, Waste and Abuse:
  • Prescribing drugs, equipment or services that are not medically necessary
  • Scheduling more frequent return visits than are medically necessary
  • Billing for tests or services not provided to you
  • Billing for more expensive services than provided
Member Fraud, Waste and Abuse:
  • Sharing your InHealth ID card with another person
  • Selling prescribed drugs or other medical equipment paid for by InHealth to others
  • Forging a doctor’s signature on prescriptions
  • Providing inaccurate symptoms and other information to providers to get
If you suspect fraud, waste or abuse
If you think a doctor or an InHealth member is committing fraud, waste or abuse, you can report your concerns to us by:
  • Calling our Compliance Hotline at 866-907-9204
  • Visiting our website at www.inhealthohio.org and reporting your concern through the Compliance Internal Messaging System;
    http://www.inhealthohio.org/fraud-waste-abuse-form
  • Sending us an email at fraud@inhealthohio.org; or
  • Sending us a letter addressed to:
    InHealth Mutual
    Attn: Compliance Officer
    501 West Schrock Road
    Suite 310
    Westerville, OH 43081
  • Mailing a Fraud Complaint with the Ohio Department of Insurance at:
    Ohio Department of Insurance, Fraud Division
    50 W. Town St., 3rd Fl.
    Suite 300
    Columbus, OH 43215
  • Calling the Ohio Department of Insurance Fraud Hotline at 1-800-686-1527; or
  • Filing a Fraud Complaint online at www.insurance.ohio.gov

In addition to reported allegations of fraud, waste and abuse, InHealth reviews medical and pharmacy claims data, reviews medical records, interviews members and providers, and works with state and federal law enforcement to identify and prevent fraud. If fraud, waste or abuse is identified, the InHealth Compliance Officer investigates and takes appropriate corrective action. Corrective actions may include, but are not limited to, dollar recovery, education and training, contract termination, disciplinary actions, law enforcement referral, Corrective Action Plans, and legal actions. All identified fraud, waste or abuse is reported to the appropriate government agencies. In circumstances where additional expertise is need, InHealth will contract with a Special Investigations individual or agency to assist the Compliance Officer with investigations.