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Fraud Prevention

Fraud Prevention

At Nippon Life Benefits, member privacy and security is of the utmost importance. There are steps you can take to protect yourself from falling victim to various types of fraud and we would encourage you to review the material below to ensure you are aware of the potential threats you may face as an insured.

Types of Fraud

Though fraud can take on many forms and vary across different businesses and industries, there are specific types related to insurance and healthcare.

Telephone Fraud

Telephone fraud has become increasingly more common as malicious groups or persons can gain access to a greater volume of potential victims by obtaining phone numbers. This type of fraud occurs whenever a scammer uses telecommunication to obtain unwarranted information. Typical types of phone fraud may include:

  • An individual posing as a representative from a known organization
  • A prerecorded (also called “robocalls”) caller attempting to deceive a person into providing personal information

 

Preventing Telephone Fraud
  • Don’t accept calls from someone you did not authorize to call you.
  • Avoid responding to prompts and recorded messages from unknown callers.
  • Be suspicious of unrecognized numbers.
  • Never provide personal information to an organization you do not recognize.
  • Use caller ID to screen calls. You can search numbers online to verify their authenticity.
  • If you are suspicious that a caller is not who they claim to be, ask for a phone number to call them back. It should be considered a red flag if the caller cannot provide a phone number for a return call.

 

Email Phishing

Similar to telephone fraud, email phishing is on the rise as mass amounts of email addresses are easy to obtain. Phishing scams are used by scammers to get the person to click a link containing malicious software or provide personal digital information. Typical phishing scams include:

  • Posing as a representative from a known organization. Often providing a link to click. Link titles are often security related, such as, “We’ve noticed some suspicious activity on your account..,” or “Please confirm your information…”
  • Providing a fake invoice in an attempt to get the receiver to provide payment information.
  • Posing as a friend or relative in need of financial assistance.

 

Preventing Phishing Scams
  • Never provide your personal information over email or text.
  • Do not open emails from unknown organizations or email addresses.
  • Pay attention to the full email address, not just the sender name.
  • Install anti-phishing software.
  • Use multi-factor authentication whenever possible.

 

Healthcare Fraud and Abuse

Although healthcare fraud happens at a slim margin, no one should assume they aren’t susceptible. Healthcare fraud and abuse occur when the care provider deliberately misuses information, products, or care to receive a benefit at the expense of the care receiver or their family outside of professional standards. Common types of healthcare fraud may include:

  • Billing for items or services that have not been rendered.
  • Billing for undocumented services or items not deemed medically necessary.
  • Seeking inflated payment or reimbursement for items that were correctly billed.
  • Misrepresenting a service location where supplies are provided.
  • Providing medical care without a valid license to do so.

 

Preventing Healthcare Fraud and Abuse
  • Safeguard your insurance member ID card just as you would a credit card.
  • Always review your Explanation of Benefits (EOB) statement for accuracy.
  • Follow up with your doctor. Ask them to explain the reason for services.
  • Be mindful of to whom you provide your insurance information.
  • Report discrepancies to your provider.

 

Additional Resources

If you are concerned about healthcare fraud or would like to report a potential incident, please do not hesitate to reach out to: https://www.justice.gov/criminal-fraud/report-fraud or contact Nippon Life Benefits Customer Service at 800-374-1835.

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