Which of the following would NOT be included on a fraud indicators list for health care program beneficiaries?

• A. Anonymous telephone or email inquiries regarding the status of a pending claim
• B. Individuals who mail their claim and ask for their claim payment to be sent through direct bank transfer
• C. Threats of legal action when a claim is not paid quickly
• D. Pressure by a claimant to pay a claim quickly

Answer: (B)

Fraud indicators for health care program beneficiaries focus on behaviors that signal an attempt to manipulate the payment process or conceal wrongdoing. Anonymous inquiries about the status of a pending claim can be used to test the system or gather information, which is a common red flag. Threats of legal action when a claim isn’t paid quickly and pressure by a claimant to pay a claim quickly are clear coercive tactics that often accompany fraudulent activity. Asking for payment to be sent via direct bank transfer, however, is simply a payment method and not, by itself, a warning sign of fraud; it can be legitimate or routine. Therefore, this option is the one that would not typically be included on a fraud indicators list.