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:
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 do not have to give your name.
Tell us of suspected waste, fraud or abuse of services paid for by Highmark Health Options.
Highmark Health Options
Attention: Payment Integrity
Four Gateway Center, Suite 2100
444 Liberty Avenue Pittsburgh, PA 15222
Fraud Hotline at: 1-844-325-6256
You may also report Fraud, Waste, or Abuse by calling the Department of Justice Provider Fraud Hotline. They can be reached by phone at 1-302-577-5000. You have the option to remain anonymous at all times.
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:
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:
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