What is health insurance fraud?

Fraud is a dishonest act where a healthcare provider or health fund member provides deceitful information or conceals information for financial gain. 

Some examples of fraud may include: 

  • Creating fake invoices
  • Claiming for services that did not occur
  • Overcharging or upcoding resulting in a higher benefit 

How does HIF tackle fraud? 

  • Our investigations team utilises sophisticated technology to detect unlikely claiming patterns and billing discrepancies to prevent and recover losses on behalf of our Members.
  • HIF has various pro-active measures in place to identify and prevent any claims or membership leakage, however, we still need your help to ensure we’re not incurring additional costs that may affect our members premiums.

What can I do?

Here are some ways you can help us combat fraud:   

  • Never leave your membership card with anyone, even a Healthcare Provider
  • Check all of the details on your invoices to ensure they are accurate – particularly with HICAPS claims
  • Frequently check your claims history and update your password via our Online Member Centre
  • Report any suspicious behaviour or irregularities to HIF

How can I report Fraud?

HIF encourages our members, health providers and the wider community to report any suspected incidents of fraud and claims abuse. Our Investigations team will review any concerns raised with the utmost confidentiality and respect your right to remain anonymous. You can report fraud in two ways: