Frequently Asked Questions

What are some common examples of fraud?

Providers

  • Billing for services not rendered
  • Paying a "kickback" in exchange for a referral for medical services or goods 
  • Unbundling 
  • Overcharging for services or goods 
  • Using false credentials
Members
  • Allowing unauthorized individuals to use ID card to obtain benefits
  • Altering prescriptions 
  • Falsifying residence information to obtain benefits
What do I do if I suspect an IEHP Member is engaging in possible fraud?

First, document your suspicions. Then, contact IEHP directly and explain the case to one of our Representatives. At times, IEHP may request additional information that is necessary to investigate the case. Thus, Provider documentation is strongly encouraged. You may also submit a Fraud Report Form along with supporting documents to IEHP. If you have any questions, please contact your IEHP Provider Service Representative.


What do I do if my facility has made some billing errors?
If you suspect that errors in billing may have occurred, contact your IEHP Provider Services Representative at (909) 890-2054.

What are some other things I can do as a Provider?

  • Periodically perform internal audits of billing practices and compare billing records with payments received.
  • Do not leave prescription pads, which include a Provider's identification and license number, out in the open. For example, do not store prescription pads in examining room cabinets or leave on office counters.