Protect yourself from health care fraud

Protect yourself from health care fraud 2017-09-13T16:27:44+00:00

Protect yourself from health care fraud

When you apply for health coverage through the Massachusetts Health Connector, you can protect yourself from fraud by following a few simple guidelines.

IMPORTANT: After you complete an application, you may get a phone call from the Health Connector or MassHealth to verify or ask for more information. See “If you get a call from the Health Connector or MassHealth” below.

Be informed about your health care choices

  • Spend some time here at MAhealthconnector.org to learn the basics about getting health coverage. It’s the official Health Connector website whose official URLs are as follows:
    • mahealthconnector.org
    • betterhealthconnector.com
  • Compare insurance plans carefully before making your decision. If you have questions, call the Massachusetts Health Connector call center at 1-877-MA-ENROLL (1-877-623-6765). TTY users should call 1-877-623-7773 . Current business hours are posted on the “Contact” page of the Health Connector website.
  • Look for official government seals and Health Connector and/or MassHealth logos on materials you see in print or online:
Health Connector Logo

(Scroll for alternative, official styles)

MassHealth Logo

(Scroll for alternative, official styles)

Massachusetts State Seal

(Scroll for alternative, official styles)

Keep in mind that the Health Connector is the only place Massachusetts residents can apply for coverage and help paying costs. If you buy through a website that isn’t the Health Connector, you could be missing out on the opportunity to get subsidies to lower the cost of your insurance.

Know the Health Connector Open Enrollment dates

The 2018 Open Enrollment period is November 1, 2017 through January 23, 2018. You may not be able to enroll in a health plan through the Health Connector website until Open Enrollment begins or after it ends unless you have a qualifying event. However, it is important to note that you can enroll any time of the year if:

  • You qualify for MassHealth.
  • You now qualify for a ConnectorCare plan through the Health Connector after not having qualified in the past, or after applying for the first time.
  • You are applying for dental coverage.
  • You are a member of a federally recognized tribe or Alaska Native shareholder.
Learn more

Protect your private health care and financial information

  • Never give your financial information—like your banking, credit card, or account numbers—to someone who calls or comes to your home uninvited, even if they say they are from the Health Connector or MassHealth. (See “If you get a call from the Health Connector or MassHealth” below.)
  • Never give your personal health information, like your medical history or specific treatments you’ve received, to anyone who asks you for it. (If you apply for certain Health Connector exemptions, you may be asked for medical documentation.)

Protect yourself when getting in-person help with an enrollment assister

All Massachusetts enrollment assisters must be certified by the Commonwealth to assist you. Certified enrollment assisters include:

  • Navigators
  • Certified Application Counselors, and
  • Issuer Enrollment Assisters

The services of a certified enrollment assister are free. An enrollment assister will never request a payment when helping you.

Ask questions and verify the answers you get

  • The Health Connector and MassHealth have trained Enrollment Assisters across the Commonwealth to help you at no cost. You should never be asked to pay for services or help to apply for coverage through the Health Connector. The Health Connector website or by calling customer service are the only places to get a list of certified Enrollment Assisters for the Commonwealth of Massachusetts.
  • When you visit an Enrollment Assister, like a Navigator, Certified Application Counselor, or Issuer Enrollment Assister:
    • Their state-issued Enrollment Assister certificate should be visible. If you don’t see one, you can ask for it.
    • An Enrollment Assister will never ask for compensation for the assistance they provide helping you fill out an application through the Health Connector.
  • Ask questions if any information is unclear.
  • Write down and keep a record of the name of an agent or anyone who may assist you, who he or she works for, telephone number, street address, mailing address, email address, and website.
  • Double-check any information that is confusing or sounds fishy. Check out MAhealthconnector.org and/or Mass.gov/MassHealth to verify information or call customer service:

Health Connector Customer Service
1-877-MA-ENROLL (1-877-623-6765), or TTY 1-877-623-7773 for people who are deaf, hard of hearing, or speech disabled.
Hours:  Monday through Friday, 8:00 a.m. to 6:00 p.m.

You can also visit a Health Connector Walk-in Center →

MassHealth Customer Service
1-800-841-2900, or TTY 1-800-497-4648 for people who are deaf, hard of hearing, or speech disabled.
Hours: Monday through Friday, 8:00 a.m. to 5:00 p.m.

You can also visit a MassHealth Enrollment Center →

What to do if you get a call or letter from the Health Connector or MassHealth

After you apply, you may get a phone call or letter from the Health Connector and/or MassHealth asking you to verify or provide more information. If we don’t have this information, we may not able to process your application.

Follow these tips to help prevent fraud

If at any time you are unsure if you have received a call from MassHealth or the Health Connector, or are not comfortable providing information, then please hang up and call MassHealth or Health Connector Customer Service directly.

The customer service representative will say they are calling from the Health Connector or MassHealth and provide a first name and may also provide their agent ID

A Health Connector or MassHealth customer service representative may leave a message on your answering machine. If this happens, you must call back as soon as possible following the instructions provided on the message. If the Health Connector or MassHealth can’t reach you by phone, you’ll get a letter in the mail telling you what to do next.

The Health Connector or MassHealth representative may ask you the following:

  • To verify your identity, using information you provided on your application, including your full name and address.
  • To provide or verify your Social Security number, application ID, policy ID, user ID, date of birth, or phone number.
  • To verify or provide income, household, and employment information, but NOT personal financial information, like a bank name and account number.They will also not ask about any personal health information, like your medical history or conditions. (If you’re applying for certain exemptions, you may be asked to provide medical documentation.)

If at any time you are unsure if you have received a call from MassHealth or the Health Connector, or are not comfortable providing information, then please hang up and call MassHealth or Health Connector Customer Service directly to ensure you are speaking to the correct agency. In certain cases, the Health Connector and/or MassHealth may request additional documentation. If you need to mail or fax any information to the Health Connector or MassHealth, the fax number and address are:

Fax: 857-323-8300

Mail:
Health Insurance Processing Center
P.O. Box 4405
Taunton, MA 02780

Do not mail or fax any information to a different address.

When to report suspected fraud

It’s time to take action if:

  • Someone other than the insurance company you’ve chosen contacts you about health insurance and asks you to pay – or asks for your financial or personal health information
  • Someone you don’t know contacts you about getting health insurance and asks you to pay – or asks you for your personal financial or health information
  • Someone contacts you and claims to be from the government or Medicare – and asks you to pay for a new “Obamacare” insurance card
  • You give your personal health, bank account, or credit card information to someone who calls you and says they’re from the government

 

How to report suspected fraud

Depending upon the type of fraud you experienced, there are a number of agencies to report suspected fraud to. Review the list below and find the one that seems best for your situation.

Health Connector Members can complete the Fraud Complaint Form and can send it via mail to the address below or by email:

Mail:

Attn: Compliance Manager
Massachusetts Health Connector Compliance Unit
P.O. Box 960189
Boston, MA 02196

Email: HCReport@state.ma.us

View and download the Health Connector’s Fraud Complaint Form. Explain what happened and your information will be handled appropriately.

If you have any questions about filing a complaint, or need to speak with someone regarding your allegation(s), please call 617-933-3079.

MassHealth Members can contact the MassHealth Member Fraud Hotline at 1-877-437-2830 (1-877-4-FRAUD-0)  http://www.mass.gov/ago/bureaus/hcfc/the-medicaid-fraud-division/
You can also go to the Massachusetts State Auditor’s web page to complete an online form to report public assistance fraud at http://www.mass.gov/auditor/report-fraud-and-waste.html, or call 617-727-6771.
If you suspect identity theft, or feel like you gave your personal information to someone you shouldn’t have, use the Federal Trade Commission’s online Complaint Assistant.
You can also report complaints against insurers, producers, and other licensees with the Massachusetts Division of Insurance (DOI) Office of Consumer Affairs and Business Regulation.
If you have problems with health insurance claims or medical bills, or think you may have fallen victim to a scam, the Attorney General’s Health Care Division may be able to help. You can file a health care complaint on their website.
If you need to report fraud, waste and abuse regarding public funds, you can contact the Massachusetts Inspector General’s Office anonymously:

You may also contact your local police department.
Need to report suspected fraud? Click for contact agencies and information.