Helping detect healthcare fraud

Why do you not include descriptions on EOB’s and the name of the actual provider?  In order to detect fraud more easily and for the average consumer to understand their EOB’s it should include a description of the service codes and the name of the provider, not just the facility name.  In my case, I reported fraud to your department for a therapist that was upcoding by charging for 60 min sessions vs 45 and they were also unbeknownst to me, your fraud investigator told me after I submitted the report, that they were also billing under the psychologists name not the social worker that was seen. On my EOB it only shows facility name I would never of known this. Both of these issues could have been caught early on if the EOB included this info. The only reason why I caught it is because I switch facilities and noticed a difference in billing. I know the forms have a lot of information already but this is very useful information and could combat the fraud more easily and discourage deceitful providers. Also it should include diagnostic code. I found this provider may have been falsifying this as well and there is nothing on the form that shows this. I’ve reported that to your investigator but I can’t prove it because it’s not shown on my EOB and the provider has denied me access to my claims and when I called customer service they told me that can’t tell me what diagnostic code was used I have to get it for the provider. Big loop hole. I now have to use google to search for the meaning of each service code In order to check that we received that service. Seems like an unnecessary step. If you  want the average consumer to help combat fraud but you should make it easier for us to catch these things. Seems like a simple solution would love to hear feedback why these things are not already included on the EOB.

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