Report Fraud and Abuse

Health care fraud is the deliberate submission of false information to gain undeserved payment on a claim.

Abuse involves a questionable practice inconsistent with accepted medical or business policies. While not an intentional misrepresentation, it may result in unnecessary costs.

• Patients
• Doctors
• Hospitals
• Clinics
• Labs
• Someone posing as any one of these individuals

Items or services on your Explanation of Benefits (EOB) which:

• You didn't receive.
• Are different from those you received.
• Are unnecessary, inappropriate, or of questionable medical benefit.
• Are billed under a different name than the individual who provided the service.

Someone who:

• Offers "free" items or services to you, but then bills them to WPS.
• Any person (other than a covered dependent) who uses your insurance identification card to obtain medical care.
• Someone who misrepresents information on a health insurance application or form.
• Submits falsified claims with stolen/purchased physician or patient identification information.

Fraudulent and abusive claims can affect your health care history. If a claim is filed for a service you didn't receive, this could:

• Affect your future ability to obtain life or health insurance.
• Increase insurance premiums.
• Affect the health care received from other providers.

• Use our online form.
• Email us.
• Call our toll-free fraud and abuse hotline: 1-888-766-4681 (TTY:711).

Visit the websites below:

• Coalition Against Insurance Fraud
• Health and Human Services Office of Inspector General
• National Health Care Anti-Fraud Association
• State of Wisconsin Department of Safety and Professional Services (DSPS)