Fraud, Waste, 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.

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 Highmark Health Options 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 health care services or items you did not get.
  • Your doctor is ordering a lot of tests or items that you do not feel you need.

Do you suspect fraud, waste, or abuse?

We have a team of people who look into all calls or mail regarding possible Fraud, Waste, or Abuse of healthcare services. You have the option to remain anonymous at all times. You don't have to give your name. Tell us of suspected waste, fraud, or abuse of services paid for by Highmark Health Options.

To report Medicaid Fraud, Waste, or Abuse, contact Highmark Health Options by mail or phone at:

Highmark Health Options
120 Fifth Avenue, 5th Floor
Pittsburgh, PA 15222
Mailcode: FAPHM-052C

Fraud Hotline: 1-844-325-6256

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 Highmark Health Options as soon as possible if your health insurance card is stolen.
  • Check all bills, statements, or health care 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 health care forms that are blank.
  • Do not share your medical records with anyone other than your doctor, clinic, hospital or other health care provider.

Additional Resources