Prevent Fraud
​Health Care Fraud, Waste and Abuse

Unity Health Insurance (Unity) is committed to improving the health of the communities we serve. This includes financial health as well as physical. Keeping your client informed of ways you can prevent health care fraud, waste and abuse helps us reach this goal. We believe an informed member is a healthier member.

What are health care fraud, waste and abuse?

Health care fraud, waste and abuse are widespread and contribute to rising costs. Learning how to recognize and prevent health care fraud, waste and abuse is important for everyone.

Fraud is defined as intentional deception or misrepresentation made by an entity or person, including but not limited to a subcontractor, vendor, provider, member, or other customer with the knowledge that the deception could result in some unauthorized benefit to a person or an entity. 

Report Fraud

Some examples of fraud are –

  • Forged or altered applications or enrollment forms
  • Filing false claims or claims for services not performed
  • Misuse of a member ID card
  • Enrolling an individual without consent

Waste is defined as an act involving payment or the attempt to obtain payment for items or services where there was no intent to deceive or misrepresent, but where the outcome of poor or inefficient methods resulted in unnecessary costs to the plan. That’s a long way of saying that inefficiencies can result in wasted money.

Abuse is defined as incidents or practices that clash with accepted, sound business, fiscal or medical administrative practices. Abuse may, directly or indirectly, result in unnecessary costs to the health plan, improper payment, or payment for services that fail to meet professional standards of care or are medically unnecessary.

Some examples of abuse are –

  • Billing for services that were not medically necessary
  • Over-charging for services or supplies
  • Misusing codes on a claim, such as upcoding or unbundling codes

How a ​your client can prevent health care fraud

​Here's a couple of ways health care fraud, waste and abuse ​can be prevented – 

  • Never signing a blank insurance form
  • Being careful about sharing Social Security numbers
  • Keeping a file of their plan’s paperwork and benefit documents, such as Explanation of Benefits statements and letters received from Unity or health care providers
  • Being suspicious of offers that are too good to be true, such as “free” medical care
  • Protecting their ID cards the same way they protect their credit cards

How to report suspected fraud, waste and abuse

If ​a client has a reason to believe that health care fraud, waste or abuse has occurred, they can report it several ways. Reports are kept confidential and there’s no need to share their name or contact information.

To report suspected fraud, waste and abuse, members can reach Unity Health Insurance’s Compliance department at –

Members can also report –

*Note: While ​your client may remain anonymous, in order to accept submissions for review by fax, the OIG Hotline requires the complaint to include a formal cover letter or the use of the downloadable complaint submission form, which is available online at