what are ways to report potential fraud waste and abuse

Which of the following are the ways to report potential fwa?

• Fraud Hotline: 1-800-488-0134 (Follow the prompts for reporting Fraud)
• Written Report: Use the Fraud, Waste and Abuse Reporting Form on www.caresource.com or write a letter and send to:

Full Answer

What is considered to be fraud, waste, or abuse?

What is considered fraud, waste, or abuse?Fraud includes false representation of fact, making false statements, or by concealment of information.Waste is defined as the thoughtless or careless expenditure, mismanagement, or abuse of resources to the detriment (or potential detriment) of the U.S. government.

How do I report welfare fraud?

Report Suspected Social Welfare Fraud. The Central Control Section of the department accepts reports of possible fraud offered by members of the public in relation to the department’s schemes. Reports are accepted by phone or in writing. All reports are dealt with in confidence.

How to report a suspected fraud?

• Name of person or entity you suspect may be committing fraud, waste or abuse.
• Address and/or telephone number of that person or entity, if you have it.
• Why you think that person or entity is involved in fraud, waste or abuse.
• Your name, phone number and email address. ...

How to report Medicaid fraud?

Those who may be aware of Medicaid and Medicare fraud can contact the Washington Attorney General's Office at (360) 586-8888, or they can email tips to [email protected]. Staff writer Colin Tiernan contributed to this report.

Which of the following are ways to report potential FWA UHC?

You can report FWA concerns to UnitedHealthcare online on uhc.com/fraud or by calling 844-359-7736. You can report other Compliance & Ethics Concerns to UnitedHealthcare online at [email protected] or by calling 800-455-4521.

What resources are available to report actual or potential Medicare compliance fraud waste or abuse?

Reports of potential non-compliance or FWA can be made to the CVS Caremark Part D Services' Fraud, Waste and Abuse Program by email at [email protected], by calling the Fraud, Waste and Abuse Hotline at 1-888-277-4149 or anonymously by calling the CVS Health Ethics line at 1-877-CVS-2040.

Where can I report fraud?

Contact the Federal Trade Commission at 1-877-FTC-HELP, 1-877-ID-THEFT, or online at https://ReportFraud.ftc.gov/#/?orgcode=TFMICF.

What are examples of fraud waste and abuse?

Examples of Fraud, Waste and AbuseBilling for services not rendered.Altering medical records.Use of unlicensed staff.Drug diversion (e.g. dispensing controlled substances with no legitimate medical purpose)Kickbacks and bribery.Providing unnecessary services to members.

How can one promptly report a potential compliance problem or concern?

Reporting Compliance Issues or ConcernsDiscuss the issue with an immediate supervisor.Discuss the issue with a higher-level manager or director.Discuss the issue with Research Integrity Officer Emily Holmes at 206-884-7863.More items...

What are ways to report a compliance issue include?

Ways to report a compliance issue include: Telephone hotlines. Report on the Sponsor's website. In-person reporting to the compliance department/supervisor....Disciplinary action.Termination of employment.Exclusion from participation in all Federal health care programs.All of the above.

How do I report a company?

File a complaint with your local consumer protection office or the state agency that regulates the company. Notify the Better Business Bureau (BBB) in your area about your problem. The BBB tries to resolve your complaints against companies.

What should I do if I suspect corruption?

You do not have to give your name when reporting fraud or corruption using:National Ant-Corruption Hotline: 0800 701 701 (toll free number)Fax: 0800 204 965 (toll free number)Post: P.O Box 582, Umhlanga Rocks 4320.E-mail: publicservicecorruptionhotline. ... SMS: 39772.

How do I report social security fraud?

You can contact the OIG's fraud hotline at 1-800-269-0271 or submit a report online at https://oig.ssa.gov/. Our investigations are most successful when you provide as much information as possible about the alleged suspect(s) and victim(s) involved.

What is the difference between fraud and waste and abuse?

One of the primary differences is intent and knowledge. Fraud requires the person to have an intent to obtain payment and the knowledge that their actions are wrong. Waste and abuse may involve obtaining an improper payment, but does not require the same intent and knowledge.

What forms of fraud and abuse may be present in a health care setting?

5 Common Types of Healthcare Fraud and How to Report Your...#5 – Kickback Schemes. ... #4 – Medically Unnecessary Services. ... #3 – Failure to Properly Charge Medicare and Medicaid Patients for Prescriptions. ... #2 – Allowing Nurses and Staff to Perform Examinations. ... #1 – Upcoding. ... Contact a Whistleblower Attorney Today.

How can health care fraud and abuse be prevented?

Preventing Health Care Fraud and AbuseConduct internal monitoring and auditing.Implement written compliance and practice standards.Designate a compliance officer, contact, or committee.Conduct appropriate training and ongoing education.Respond appropriately to detected offenses and develop corrective action.More items...•

What are examples of issues or questions that can be reported using the compliance and ethics Action Line?

These are examples of issues that can be reported to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA); potential health privacy violation, and unethical behavior/employee misconduct.

What is Medicare fraud Waste abuse?

Medicare Learning Network® LESSON 1 PAGE 3. Waste and Abuse. Waste includes practices that, directly or indirectly, result in unnecessary costs to the Medicare Program, such as overusing services. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources.

How do I report Medicare fraud in California?

​​​​​​​​​​​​​​ Do You Suspect Medi-Cal Fraud? Report it. ​The Department of Health Care Services (DHCS) asks that anyone suspecting Medi-Cal fraud, waste, or abuse to call the DHCS Medi-Cal Fraud Hotline at 1-800-822-6222. If you feel this is an Emergency please call 911 for immediate assistance.

What should be reported to compliance department?

You can report a wide variety of issues, including but not limited to:Conflicts of Interest.Embezzlement or Fraud.Kickbacks.Ethical Standards Violations.Medical Billing Irregularities. Billing for services not rendered or items not provided. ... HIPAA.Patient Privacy Rights / Other Patient Rights.Policy Violations.More items...

I am a Federal executive branch civilian employee (and I do not work for the Federal Bureau of Investigation or the Intelligence Community)

Retaliation involving most personnel actions, such as termination, demotion, suspension, or reassignment: You may have the option of submitting a retaliation complaint with the U.S. Office of Special Counsel (OSC). OSC is an independent federal investigative and prosecutorial agency.

I am an Intelligence Community employee

You may have the option of submitting a retaliation complaint with the Office of the Inspector General that has oversight over your employing agency, including the:

I am a contractor, subcontractor, grantee, subgrantee, or personal services contractor for the federal government

Employees of federal contractors, subcontractors, grantees, subgrantees, and personal services contractors can use the list of OIGs to determine where to file a complaint of whistleblower retaliation.

I am an employee of a State, local or tribal government

You may have the option of submitting a retaliation complaint with the Department of Labor’s (DOL) Occupational Safety and Health Administration’s (OSHA) Whistleblower Program.

I am an employee of the Federal Bureau of Investigation

If you are an employee of the FBI, you may submit a retaliation complaint to the Department of Justice (DOJ) OIG Hotline, or to the DOJ Office of Professional Responsibility (OPR). The DOJ OIG or the OPR will review reprisal complaints made by FBI employees and conduct investigations of such complaints.

I am a member of the uniformed armed services

If you are a member of the uniformed Military Services, you may have the option of submitting a retaliation complaint with Department of Defense OIG or the IG for your service component. The Department of Defense OIG has prepared a “Guide to filing a military reprisal complaint.”

I am a member of the Commissioned Corps of the U.S. Public Health Service

If you are a member of the Commissioned Corps of the U.S. Public Health Service, you may submit a retaliation complaint to the U.S. Department of Health and Human Services Office of Inspector General. Additional information regarding reprisal complaints for PHS Commissioned Corps Officers can be found here.

What is the EPA's hotline?

We were created pursuant to the Inspector General Act of 1978, as amended Exit. OIG Hotline: 1-888-546-8740.

What is fraud, waste and abuse?

Fraud, Waste and Abuse: Indicators and Examples. Fraud is a false representation about a material fact. Waste involves the taxpayers not receiving a reasonable value for money in connection with any government-funded activities due to an inappropriate act or omission. Abuse involves behavior that is deficient or improper when compared ...

What is healthcare fraud?

What is Health Care Fraud, Waste and Abuse? Fraud occurs when someone knowingly and willfully submits a false claim that results in inappropriate payments. Waste is overuse of services or other practices that, directly or indirectly, results in unnecessary medical costs.

How can clever care help?

You can help Clever Care Health Plan to prevent, detect, and correct health care fraud by reporting any suspicious activity. When you report a situation that may be potential health care fraud, waste, and abuse, you are essentially helping to make our health care system better.

What is a phishing scam?

When people claim to be from a trustworthy entity or group in order to get your personal information, they are committing a phishing scam. Phishing tries to obtain information like credit card details, Social Security numbers, and health information to use in fraudulent activity or theft.

What is abuse in medical terms?

Abuse is an action that may result in unnecessary medical costs. When a person or entity unknowingly or purposely misrepresents fact to obtain payment, this is abuse.

What to do if you lose your clever care card?

Be careful about disclosing your personal information. If you lose your Clever Care ID card, report it to us immediately.

What is member services?

Member Services can help you with explaining bills, claims and coverage. They can also help to find you network providers, like doctors, clinics, or hospitals.

What to do if you suspect health insurance fraud?

If you suspect you may be a victim of health insurance fraud, report it immediately.