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ForeverCare

Fraud and Abuse




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. 

  1. 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.
  2. 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.
  3. Abuse: Provider practices that are inconsistent with sound fiscal, business or medical practices  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:

ForeverCare
Attention: Payment Integrity 
Four Gateway Center, Suite 2100
444 Liberty Avenue Pittsburgh, PA 15222

Or call the Fraud Hotline at: 1-800-447-0912 


Keep track of your health services

When you get healthcare services, record the dates on a calendar and save the receipts and statements you get from your doctor to check for mistakes. You should keep track of these things:

  • Who provided your healthcare
  • What services you got during the visit and any tests or visits the doctor ordered
  • Where the healthcare visit took place
  • The date of your healthcare visit

Keeping track of your health services will not only help you to improve your health, it will also help you to know when there is a problem such as fraud.

Ways to protect yourself from Fraud, Waste and Abuse

  • Do not give your health insurance card or card numbers to anyone other than your doctor, clinic, hospital or other healthcare provider
  • Call ForeverCare as soon as possible if your health insurance card is stolen
  • Check all bills, statements, or healthcare information you get. Make sure that the information is correct. If something does not look right, call us as soon as possible so we can look into it
  • Do not sign your name to any healthcare forms that are blank
  • Do not share your medical records with anyone other than your doctor, clinic, hospital or other healthcare provider