Help Prevent Health Plan Enrollment Fraud
Health plan enrollment fraud occurs when a person or company intentionally misrepresents
facts to improperly receive health care products and services. This includes adding
a person who is not eligible for health plan coverage as a dependent on a health
Employers generally are required to cover the spouse or dependent child of employees
who meet health plan coverage requirements. However, some employees add people who
do not qualify as dependents onto their health plan.
It is a criminal offense under state and federal laws to fraudulently enroll someone
onto a health plan. Enrolling ineligible dependents can lead to increased health
care costs for employers. Penalties include fines, immediate loss of health plan
coverage, or imprisonment.
What employers can do
You can help prevent enrollment fraud. HMSA recommends that employers regularly
check the status of their employees’ dependents covered under their group health
plan. You should do this at least once a year during open enrollment.
- If an employee gets a divorce, their former spouse may not be eligible to remain
on the health plan.
- An employees’ child who is no longer considered a legal dependent may not be eligible
to remain on the health plan.
If you suspect any type of health plan fraud, call HMSA’s confidential fraud hotline
at (808) 948-5166 on Oahu or 1 (888) 398-6445 toll-free on the Neighbor Islands and the