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Fraud and Abuse

Health Choice Insurance Co. is committed to enforcing program standards. We take the delivery of services very seriously. We go to great lengths to follow program standards. This helps us ensure we manage correctly. It also helps to ensure you get the services you need. We inform both Members and providers of ways they can help avoid fraud and abuse.

Members are in charge of taking care of their ID cards. Using the card in a way that is wrong is against the law. Some examples of misuse include loaning, selling, or giving it to someone else. Only the Member should use their own ID card. Letting someone else use your card could result in losing benefits entirely. This is stated in Federal and State law.

Fraud includes deception by a person with the intent to wrongly benefit him/her. It includes any act that is defined as fraud under Federal or State laws. This includes:

  • Using another person’s name as your own
  • Using an ID card that does not belong to you
  • Giving your ID card to someone else
  • Misuse of services
  • Billing for services that were not provided
  • Giving false information on your records: This includes records that relate to your eligibility for Health Insurance Marketplace services.

Abuse (of Member) means provider practices that do not follow sound fiscal, business or medical practices. These result in an unnecessary cost to the Health Insurance Marketplace. This can include payment for services that are not medically necessary or that do not meet standards for health care. It also includes actions from Members that result in added costs to the Health Insurance Marketplace program.

If you are aware of any improper use of any ID card or any other type of fraud or abuse, please contact Member Services.

What if I know of or think there may be Health Insurance Marketplace fraud?

If you think an HCE provider is involved with fraud, please contact:

Health Choice Insurance Co.
Compliance Officer
855‐452‐4242

Fraud & Abuse

Health Choice Insurance Co.

For information and assistance, call toll-free: 1-855-452-4242

To obtain language or ASL interpretation services for your medical care: 1-855-452-4242

TTY/TDD: 711

You may also contact us by e-mail at

HOURS OF OPERATION

Member Services
Monday – Friday (except holidays),
8 a.m. – 5 p.m.

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