Contact the Moda Health Special Investigations Unit immediately if you are aware of healthcare fraud or feel you may be a victim.
Healthcare fraud is an intentional deception or misrepresentation made knowing that the misrepresentation could result in an unauthorized benefit.
The most common kind of fraud involves a false statement, misrepresentation or deliberate omission. Every year in the United States, more than $2.5 trillion is spent on healthcare. It is estimated that at least 3 percent of healthcare spending is lost to healthcare fraud. Loss due to fraud impacts our members, groups, taxpayers and government through increased healthcare costs, premiums and taxes. Healthcare fraud often hurts patients who may be subjected to unnecessary or unsafe procedures. Victims of medical identity theft might end up with incorrect information in their medical record that could impact future healthcare including the ability to obtain insurance because of a false medical profile.
The most common fraudulent acts include the following:
Moda Health is committed to identifying, investigating and preventing healthcare fraud and abuse. Our dedicated Special Investigations Unit is staffed with experienced fraud investigators working exclusively for the benefit of our customers. Moda Health uses fraud detection tools including software that identifies inconsistencies prior to claims being paid. Safeguards are put in place to protect our members, groups and providers against healthcare fraud.
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We have exciting news to share. ODS is changing its name to Moda Health.
Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.
Together, we can be more, be better.
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