1. Provide training.
Train your team to recognize fraudulent documents. For example, “when you’re looking at [identification] issued by the federal government, you will normally have security features in each of those documents you should look for,” said Whitlock. “You can be found guilty of hiring an illegal alien and pay a very hefty price if you don’t verify the person you are hiring is actually a U.S. citizen. You need to be able to check the documents and authenticate them.”
2. Install systems.
Systematically test common upcoding against all bills. “Have a system, and if you don’t have one, hire an outside company to do it,” he said. “So many companies have this capability. … how good of a job they do is often dictated by what you ask for in the contract so negotiate a tough contract and demand they police upcoding and catch fraudulent activity.”
3. Empower plan members.
Make it easy for employees to report suspicious behavior through a fraud line. “People have ‘report fraud’ lines where they use third parties — why can’t they report to a third party you contract with if they suspect fraud is going on?” said Whitlock, adding employers may want to consider giving the fraud line information to their providers as well.
4. Educate employees.
Hold staff meetings about the four common areas of fraud — misrepresentation of services provided, providing unnecessary services, billing for services not rendered, and sale of durable goods — and issue a fraud card listing the four areas, along with the fraud line number.
5. Stay up-to-date.
Sign up to receive the FBI Medical Fraud Alert Warnings. “They have an alert that will tell you some of the latest scams,” he said.