Fraud & Abuse

Fraud increases the cost of health care for everyone and increases your Federal Employees Health Benefits Program premium. OPM's office of the Inspector General Investigates all allegations of fraud, waste or abuse in the FEHBP program regardless of the agency that employs you or from which you retired.

If you suspect that fraud, waste or abuse is being committed, please report it to our Fraud & Abuse Compliance hotline at 1-800-793-6745 or by sending an email to Compliance@axa-assistance.us

 

Or by writing to:

AXA-Assistance USA, Compliance Officer
122 S. Michigan Avenue Suite 1100
Chicago, IL 60603
United States of America

All reports are treated as confidential and will be investigated appropriately, including applicable referral to law enforcement and regulatory bodies. Please include as much detail as possible to ensure our ability to investigate each issue. Reports may be made anonymously.

Here are some resources that we hope will help you clarify these terms and make it easier for you to recognize what they look like.

DEFINITIONS

Fraud: means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable Federal State Law.

Abuse: means provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to he FEHBP program, or in reimbursement for services that are not medically necessary or fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the FEHBP program.

EXAMPLES OF FRAUD AND ABUSE

Falsifying claims

  • Alteration of a Claim
  • Incorrect Coding
  • Double Billing
  • False Data Submitted

Falsifying Services

  • Billing for Services/Supplies Not Provided
  • Misrepresentation of Services/Supplies

Administrative/Financial

  • Kickbacks
  • Falsifying Credentials