Fraud and Abuse

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Fraud increases the cost of healthcare for everyone including you in the form of increased premiums, co-pays and co-insurance. All allegations of healthcare fraud, abuse and/or waste will be properly investigated by the AXA Assistance USA Compliance Department and any applicable federal or state regulatory agency.

If you suspect that fraud, waste or abuse is being committed, please contact our Fraud and Abuse Hotline at 1-800-793-6745 or write to:

AXA-Assistance USA, Compliance Officer
122 S. Michigan Avenue Suite 1100
Chicago, IL 60603
United States of America

All reports are confidential and will be investigated appropriately, including applicable referral to law enforcement and regulatory agencies. Please include as much detail as possible to ensure our ability to investigate each issue. Reports may be made anonymously.

Below are some resources that will help clarify terms and make it easier to recognize what we need your assistance with.

Definitions

Fraud: An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable Federal State Law.

Abuse: Provider practices that are inconsistent with sound fiscal, business or medical practices. This results in an unnecessary cost or in reimbursement for services that are not medically necessary or fail to meet professionally recognized standards for healthcare.

Examples of Fraud and Abuse

Falsifying claims

  • Alteration of a claim
  • Incorrect coding
  • Double billing
  • False data submitted

Falsifying Services

  • Billing for services/supplies not provided
  • Misrepresentation of services/supplies

Administrative/Financial

  • Kickbacks
  • Falsifying credentials
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