Fraud and Abuse - WellChoice

In cooperation with the New Jersey State Department of Banking and Insurance, Division of Anti-fraud Compliance, WellChoice maintains a toll-free hotline, 1-800-IC-FRAUD, that individuals can use to report suspected fraud or abuse against WellChoice. If information provided on the hotline leads to an arrest, prosecution, and conviction, the company may grant a reward of up to $25,000. To assist us in our anti-fraud efforts, anyone who suspects that fraud is taking or has taken place in connection with the filing of an insurance claim with WellChoice is urged to call the hotline number to make a report. Reports may be made anonymously, but we prefer to speak with you directly to obtain all of the facts surrounding the allegation you are making. Your help is crucial in helping us stem the tide against insurance fraud.

Fraud includes:

Billing for services not furnished
Incorrect reporting of diagnoses or procedures to maximize payments
Billing that appears to be a deliberate application for duplicate payments of services
Misrepresentations of dates, descriptions of services or identities of subscribers/providers
Billing for non-covered services as covered items (e.g. cosmetic)
Providing false employer group and/or group membership information

What To Do If You Suspect Fraud:

You should contact the Fraud Department using the following
e-mail address: icfraud@wellchoice.com,
or call the Fraud Hotline at, 1-800-IC-FRAUD.