Healthcare fraud is an intentional deception or misrepresentation that an individual or entity makes, knowing that the misrepresentation could result in some unauthorized benefit to the individual, the entity or some other party. Recent estimates put the impact of healthcare fraud in the United States at approximately $60 billion per year. Healthcare fraud is costly for everyone. It leads to higher premiums, more uninsured people and fewer dollars available for healthcare services.
Healthcare fraud comes in many forms, including:
- Submission of fraudulent claims (e.g., billing for services that were not provided or inappropriately coding claims to result in higher charges)
- Use of health plan ID cards by people who are not entitled to benefits
- Falsification of drug prescriptions
Sharp Health Plan is committed to working to reduce fraudulent activity. It is the goal of Sharp Health Plan to improve the detection and investigation of fraud. In pursuit of that goal, we have joined forces with the legal and regulatory communities to prosecute those parties attempting to abuse the healthcare system.
If you suspect fraud, abuse or waste
What if you suspect fraud? Contact us immediately. Call our Regulatory Affairs Department at (858) 499-8237, or email firstname.lastname@example.org. Or send a letter to:
Sharp Health Plan
Fraud and Abuse Investigations
8520 Tech Way, Suite 200
San Diego, CA 92123
You do not have to give your name. Just tell us why you think fraud is occurring. Give us the name of the provider or member, and tell us what you are concerned about. We take your questions and input seriously. You can help us stop healthcare fraud.