Health care fraud costs taxpayers about $36 billion a year. When providers or members misuse or mismanage resources, the resulting costs are detrimental to our mission and our government partners.
AmeriHealth Caritas has made health care fraud prevention and detection a primary emphasis. Across the enterprise, we are increasingly focused on preventing improper payments rather than a "pay and chase" method of recovery.
AmeriHealth Caritas has numerous processes in place system-wide—all designed to prevent and detect FWA. They include:
Special Investigations Unit (SIU)
All cases of suspected FWA are reported to the state Medicaid oversight entity and applicable law enforcement agencies.