Help Prevent Health Plan Enrollment Fraud

Health plan enrollment fraud occurs when a person or company intentionally misrepresents facts to improperly receive health care products and services. This includes adding a person who is not eligible for health plan coverage as a dependent on a health plan.

Employers generally are required to cover the spouse or dependent child of employees who meet health plan coverage requirements. However, some employees add people who do not qualify as dependents onto their health plan.

It is a criminal offense under state and federal laws to fraudulently enroll someone onto a health plan. Enrolling ineligible dependents can lead to increased health care costs for employers. Penalties include fines, immediate loss of health plan coverage, or imprisonment.

What employers can do

You can help prevent enrollment fraud. HMSA recommends that employers regularly check the status of their employees’ dependents covered under their group health plan. You should do this at least once a year during open enrollment.

For example:

• If an employee gets a divorce, their former spouse may not be eligible to remain on the health plan.
• An employees’ child who is no longer considered a legal dependent may not be eligible to remain on the health plan.

If you suspect any type of health plan fraud, call HMSA’s confidential fraud hotline at (808) 948-5166 on Oahu or 1 (888) 398-6445 toll-free on the Neighbor Islands and the Mainland.