Hello all,

Just looking for opinions. We are heavily in the Health Savings Account (HSA) line of business and have, as a result of trial and error, seen a lot of fraud - and, obviously, SARs.

This seems like such a simple question, but we haven't been sure where to go on this. On the SAR report itself, under "Fraud", there is the option of checking off "Healthcare Fraud". What are your thoughts? We hadn't been checking it off up to this point, cuz it is really more of an account fraud and check fraud, but the argument *could* be made that we should be checking that box since it is a type of account that exists specifically because of the way our healthcare system is set up in this country.

Thoughts?

Healthcare fraud is fraud against the United States government and, perhaps, insurers.

Okay, I guess it gets a little tricky because technically, the money that goes into an HSA is pre-tax. So you could argue that the government is maybe being defrauded because taxes aren't being paid on those funds?

Just playing devils advocate here.

I assume that box is for insurance companies.

What fraud are you talking about? What are they doing?

So, in the case I am referencing, someone (they think it was a company insider) took the information of 116 employees that worked at ABC Co. and used the info to sign up all of the employees for HSAs through a Third Party Administrator (TPA). They then funded a handful of the accounts via ACH deposits from other financial institutions. Then, they went to Wal-Mart and Walgreens with the HSA debit cards and withdrew all of the funds via POS. A day or so later, the ACH were returned as "No Account". Perp is gone and the Bank is out over $50K.

It's identity theft, ACH fraud, and account fraud... but couldn't you consider it also healthcare fraud as the perpetrator took advantage of the TPA to sign up all the employees for health accounts and utilized the HSA debit cards at the pharmacies (as mandated by our overly complicated healthcare system)?

It's kind of annoying to even be asking this question because I am only doing so to avoid getting dinged during an audit for potentially missing a box.

There is nothing in this situation that involved healthcare fraud. The fraud did not involve healthcare. It was purely account fraud that involved HSA accounts.

Thank you for the responses.