Fraud, Waste, and Abuse Hurts Everyone.
It can even raise the cost of getting healthcare services. This is why we need help from our members and providers to find Fraud, Waste, or Abuse and stop it as soon as possible. But, before we tell you how you can help, let us help you understand what health insurance fraud, waste, and abuse looks like.
- Fraud: Any intentional deception or misrepresentation made by a person
with the knowledge that the deception could result in some unauthorized benefit
to himself, herself or some other person. It includes any act that constitutes
fraud under applicable federal or state law.
- Waste: Involves the taxpayers not receiving reasonable value for money in
connection with any government funded activities due to inappropriate act or
omission by player with control over, or access to, government resources.
- Abuse: Provider practices that are inconsistent with sound fiscal, business or
and result either in an unnecessary cost to the
Federally funded programs or in reimbursement for services that are not
medically necessary or provider practices that fail to meet professionally
recognized standards for healthcare. It also includes recipient practices that
result in unnecessary cost to the federally funded programs.
How YOU can help prevent Fraud, Waste and Abuse.
As our Member, you play an important role in helping us find Fraud, Waste, or Abuse. If you feel that Fraud, Waste, or Abuse might be happening, report it as soon as you can. Here are some examples of possible fraud:
- Someone pretends to be from ForeverCare, Medicaid or Social Security and asks for your Social Security number, bank account or credit card numbers, money, etc.
- A healthcare provider offers you cash or gifts to get free medical care
- A pharmacy bills you for drugs you did not get, or the pharmacy did not give you the right number of pills ordered by your doctor
- You find out someone else is using your health insurance card
- You are billed for healthcare services or items you did not get
- Your doctor is ordering a lot of tests or items that you do not feel you need
If you suspect Fraud, Waste, or Abuse, call us at 1-800-447-0912 so we may look into your concerns. You have the option to remain anonymous at all times. You do not have to give your name. ForeverCare has a team of people who look into all calls or mail regarding possible Fraud, Waste, or Abuse of healthcare services.
To report Medicare or Medicaid Fraud or Abuse you may contact ForeverCare by mail or phone at:
Attention: Payment Integrity
Four Gateway Center, Suite 2100
444 Liberty Avenue Pittsburgh, PA 15222
Or call the Fraud Hotline at: 1-800-447-0912