Aetna Member website opens in a new window
Express Scripts Online opens in a new window

Find a Provider opens in a new window

How to enroll

Search
Close this search box.

Foreign Service Benefit plan

Caring For Your Health Worldwide®

Health care fraud and abuse

What is health care fraud and abuse?

  • Fraud is an intentional deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment or benefit. The attempt itself is fraud, regardless of whether it is successful.
  • Waste is the expenditure, consumption, mismanagement, use of resources, practice of inefficient or ineffective procedures, systems, and/or controls to the detriment or potential detriment of entities. Waste is generally not considered to be caused by criminally negligent actions but rather the misuse of resources. Waste can be committed by a contractor, a subcontractor, a provider, and/or a FEHB beneficiary/enrollee.
  • Abuse typically involves incidents or practices of providers that are inconsistent with accepted medical, business, or fiscal practices. These practices may, directly or indirectly, result in unnecessary costs, improper payments, or payments for services that fail to meet professionally recognized standards of care, or that are medically unnecessary.
  • Billed services not performed by a provider of care
  • Intentionally misrepresenting facts regarding the payment of benefits
  • Routinely waiving co-payments or deductibles
  • Billing for medically unnecessary items or services
  • “Unbundling” claims, or separate billing procedures instead of using a more appropriate global billing procedure
  • Upcoding claims, or billing at a higher rate than is appropriate for the item or service provided
  • Misrepresenting facts affecting eligibility for benefits, such as: employment status, health history, marital or student status, identity
  • Review your Explanation of Benefits (EOB) and compare to the services billed by your doctor. If there’s a difference between your EOB and medical bill, contact FSBP.
  • Protect your health insurance information. Do not share your health insurance ID card with anyone other than an authorized health care provider or your insurance plan.
  • Be suspicious of free medical services that require your insurance information.
  • Inform us of any provider of care that routinely waives your copayments or deductibles.
  • Visit OPM.gov for more tips on identifying, preventing and reporting fraud.

Call our Special Investigations Unit (SIU) dedicated hotline to report suspected fraud and abuse activities at 1-866-806-7020 (TTY: 711) and select option 1. Simply leave a message and it will be reviewed promptly. You may also contact our customer service at 1-202-833-4910 (TTY: 711) to make a report. If we do not resolve the issue, you may call the Office of Personnel Management Office of the Inspector General health care fraud hotline at 1-877-499-7295.

For more information on health care fraud and abuse, refer to the official Plan brochure.

Visit the U.S. Office of Personnel Management/Office of the Inspector General website

Visit the National Health Care Anti-Fraud Association website

Visit the Coalition Against Insurance Fraud website

Quick Links:

Share this page:

Facebook Twitter Envelope Google-plus Linkedin

Have questions? We’re here.

Call 1-202-833-4910

We’re here to assist you every step of the way with your health care needs.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). This is a brief description of the features of the Foreign Service Benefit Plan (FSBP). Before making a final decision, please read the Official Plan brochure. All benefits are subject to the definitions, limitations and exclusions set forth in the Official Plan brochure. 

©2025