Report Fraud, Waste and Abuse
What is Fraud, Waste and Abuse?
Fraud, Waste and Abuse is a serious problem in health care requiring your attention. Anyone can commit healthcare fraud.
- Fraud is knowingly and willfully performing, or attempting to perform, a scheme to take advantage of any health care benefit program. Obtain by means of false or deceitful pretenses any of the money or property owned by, or under the custody or control of, any health care program.
- Waste is an overuse of services or other practices that result in excessive cost.
Waste is usually caused by a mistake rather than unlawful actions.
- Abuse is an action that results in greater costs. Examples may include improper payment,
payment for services that fail to meet standards of care, or services that are not medically necessary.
How does Fraud, Waste and Abuse affect you?
Recent studies show that an estimated 60 billion dollars a year are lost to health care fraud in the United States. Most doctors are honest but there are a few doctors who abuse the system. This can cost taxpayers billions of dollars. This can put your health and wellbeing at risk. Health care fraud, waste and abuse affects by you having to pay higher co-payments and/or premiums. This means more money coming out of your pocket.
Examples of Fraud, Waste or Abuse
- Doctors billing for services not rendered.
- Members selling their prescription drugs.
- Brokers selling nonexistent policies.
- An unauthorized person using a members' ID card or a member loaning their ID card to someone to use it.
- Doctors changing medical records.
- Members receive a different drug than the doctor prescribed.
- Doctors performing services that are not necessary.
- Members giving false information on applications.
- A booth at the fair taking samples and billing your insurance.
- Telephone or door-to-door medical equipment sales.
- Insurance company giving away free meals while trying to sell you their plan.
How to help Health Net fight Fraud, Waste and Abuse
Help us fight Fraud, Waste and Abuse. If you see anything suspicious please report it. If you suspect health care Fraud, Waste or Abuse you can do the following:
- Call the Health Net Compliance Hotline toll free 1-866-685-8664.
- You may also report to the Oregon Department of Justice by calling 1-877-877-9392 or online at www.oregonconsumer.gov.
- You may also contact the Centers for Medicare & Medicaid Services (CMS) at 1-800-633-4227, TTY: 1-877-486-2048.
All calls and information received by Health Net are handled confidentially.
Contact us for more information:
Confidential Compliance Hotline: Toll Free 1-866-685-8664.
The Health Net Compliance Hotline is available 24/7. All callers may choose to remain anonymous.
Health Net Health Plan of Oregon, Inc.
13221 SW 68th Parkway, Ste 200
Tigard, OR 97223