It can even raise the cost of getting health care services. This is why we need help from our members and providers to find fraud, waste, and abuse and stop it as soon as possible.
As our member, you play an important role in helping us find fraud, waste, and abuse. If you feel that it might be happening, report it as soon as you can. Here are some examples of possible fraud:
We have a team of people who look into all calls or mail regarding possible fraud, waste, and abuse of health care services. You do not have to share your name when making a report. Tell us of suspected waste, fraud, and abuse of services paid for by Highmark Health Options.
Highmark Health Options
120 Fifth Avenue, 5th Floor
Pittsburgh, PA 15222
Fraud Hotline: 1-844-325-6256
When you get health care 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:
Keeping track of your health services will not only help you to improve your health, but it will also help you to know when there is a problem such as fraud. Ways to protect yourself from fraud, waste, and abuse:
Watch the Medicare/Medicaid Fraud Waste and Abuse Training Video
Additional educational resources can be found:
Centers for Medicare and Medicaid Services (CMS)
Provider Fraud, Waste and Abuse Training Document
Fraud and Abuse Laws, Regulations, and Definitions