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Health Care Fraud, Waste and Abuse Prevention

Health Care Fraud, Waste and Abuse Prevention

What are health care fraud, waste and abuse?

Health care fraud, waste and abuse are so widespread, that it’s a factor in the rising costs of all health care. So how can you avoid being a victim? Learning how to recognize and prevent health care fraud, waste and abuse are good places to start.
Fraud is defined as intentional deception or misrepresentation made by an entity or person, including but not limited to a subcontractor, vendor, provider, member or other customer with the knowledge that the deception could result in some unauthorized benefit to a person or an entity.

Some examples of fraud are –

  • Forged or altered applications or enrollment forms
  • Filing false claims or claims for services not performed
  • Misuse of a member ID card
  • Enrolling an individual without consent

  • How to report suspected fraud, waste and abuse

    If you have reason to believe that fraud, waste or abuse has happened, you have a few reporting options. You do not need to give your name or contact information and reports
    are kept confidential*.

    To report suspected fraud, waste and abuse, you can reach Unity Health Insurance’s Compliance department at –

    • Local phone number: (608) 644-3495
    • Toll-free Number: (844) 492-2996
    • Email: [email protected]

    You can also report –

    • By visiting CMS’ State Contacts Database at cms.gov/apps/contacts
    • By contacting the Office of Inspector General’s (OIG) National Fraud Hotline –
      • Phone: (800) 447-8477
      • Fax*: (800) 223-8164
      • TTY: (800) 377-4950
      • Visit OIG online at oig.hhs.gov

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