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 fraud, waste, and abuse of services paid for by Highmark Health Options.
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
Centers for Medicare and Medicaid Services (CMS)
Provider Fraud, Waste, and Abuse Training Document (PDF)
Fraud and Abuse Laws, Regulations, and Definitions