Addressing Fraud, Waste and Abuse

As part of our efforts to improve the health care system and our organization, Aflac Benefits Solutions, Inc. (ABS) has made a commitment to detecting and preventing fraud, waste, and abuse. Success in this effort is essential to maintaining a health care system that is affordable for everyone. Below is information on how physicians, other participating providers, and business partners can help ABS with detecting, preventing, and correcting fraud, waste, and abuse.

What are Fraud, Waste, and Abuse?

Fraud is defined as knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program, or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program.

Waste includes overusing services, or other practices that, directly or indirectly, result in unnecessary costs to the health care system, including the Medicare and Medicaid Programs. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources.

Abuse includes actions that may, directly or indirectly, result in unnecessary costs to the Medicare or Medicaid Program. Abuse involves payment for items or services when there is not legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment.

One of the primary differences between fraud, waste, and abuse is intent and knowledge. Fraud requires intent to obtain payment and the knowledge that the actions are wrong. Waste and abuse may involve obtaining an improper payment or creating an unnecessary cost to the Medicare or Medicaid Program, but does not require the same intent and knowledge.

How to Report Fraud, Waste, and Abuse

If you suspect fraud, waste, or abuse in the health care system, you must report it to ABS, or one of the external sites listed below, so that it can be investigated. Your actions may help to improve the health care system and reduce costs for our members, customers, and business partners. To report suspected fraud, waste, or abuse, please contact the ABS Compliance Officer through one of the methods listed below. The only anonymous method listed below is through physical mail.

If you are enrolled with dental or vision coverage administered by Aflac Benefits Solutions, you can call the number on your ID card.

You may also report using the following contacts:

Compliance Hotline: (813) 283-1276

Compliance Fax: (813) 347-9270

Compliance E-mail: compliance@aflac.com

Physical Mail: Aflac Benefits Solutions, Inc., Attn: Compliance Officer, 4211 W. Boy Scout Blvd Ste 295, Tampa, FL 33607

If you are a Medicare member, you may call 1-800-MEDICARE to report, or call the number on your ID card.