Fraud & Abuse

What Is Fraud and Abuse?

Fraud is the intentional deception or misrepresentation of material facts with the knowledge that the deception could result in unauthorized benefit or payment for which no entitlement would otherwise exist.

Abuse is practices that are inconsistent with sound fiscal, business or medical practice and result in an unnecessary cost to Renaissance or in reimbursement for services that are not medically necessary, violations of an agreement or certificate of coverage or failure to meet professional recognized standards for health care.

What can you do?

• Treat your health benefits identification like a credit card.
• Don’t let anyone borrow your card. If it is lost or stolen, contact customer service right away at 888-358-9484.
• Protect yourself from identity theft.
• Look carefully at each Explanation of Benefits (EOB) statement you receive.
• After you’ve visited a doctor’s office, an EOB is issued informing you what has been billed.
• Make sure you had the visit or service on the date stated on the EOB. If it doesn’t seem right, call the doctor or other health care provider and ask them to explain it to you. If you want some help reading an EOB, please call Customer Service.

Report Fraud and Abuse

If you suspect someone of fraud or abuse, please help us keep costs down. Contact us immediately. You may remain anonymous or share your contact information and request that your name not be used.

Call our Anti-fraud Hotline at 888-358-9484.
Complete and submit the Fraud or Abuse Complaint Form. Please provide a detailed account of the incident or service(s).