What is Fraud and Abuse
Fraud is when a person does something on purpose so that the person gets something he or she shouldn't. If a person tries to get health care from a doctor by using another person's Healthy Advantage (HMO) card, that is one type of fraud. Another type of fraud is if a doctor bills Healthy Advantage (HMO) on purpose for a service that wasn't done.
Abuse is when a person does something that costs Healthy Advantage (HMO) or the Medicare program extra money. If a Healthy Advantage (HMO) member goes to the emergency room when it isn't really an emergency, that is one type of abuse. Another type of abuse is when a doctor does more services than the patient needs.
What can I do to stop fraud and abuse?
- Do not give your ID number to anyone except your doctor or provider.
- Do not ask your doctor or other provider for health care that you do not need.
- If you are offered free health care in exchange for your ID card number, call Healthy Advantage (HMO).
- If someone says they know how to make Healthy Advantage (HMO) pay for health care that we do not pay for, please call us.
- Do not let anyone use your ID card.
- Call us if a provider tries to make you pay for your care (except for your co-pay if you have one).
What can I do if I supect fraud and abuse?
Fill out the Fraud and Abuse Reporting form above or call Healthy Advantage (HMO)'s Compliance Officer at 1-877-644-0344, Monday through Friday 8:00 a.m. - 8 p.m. You don't even have to tell us your name if you don't want to.