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Fraud/Abuse

See It. Say It. Fix It.

There are several ways you can report suspected fraud, waste, and abuse:

Call the Compliance Hotline: 1-800-8-ETHICS (1-800-838-4427)
The hotline is anonymous and available 24 hours a day, 7 days a week!
        Or
Submit an anonymous compliance referral form!

  • Click here to complete the form and either e-mail or mail it to the Plan.

Phoenix Health Plans (HMO) is committed to reporting suspected fraud, waste and abuse and as part of our effort to provide quality services and reduce health care costs.

What are fraud, waste, and abuse?

Fraud: Knowingly and willfully obtaining or attempting to fraudulently obtain money from any health care benefit program.

Waste: Overuse or underuse of services that directly or indirectly result in unnecessary costs to the Medicare Program that is generally unintentional.

Abuse: Payment or billing practices that directly or indirectly result in unnecessary costs to the Medicare Program that is generally unintentional.

Examples of fraud, waste, and abuse:

Fraud
- Billing for services not provided
- Altering medical records
- Medical identity theft

Waste
- Excessive office visits
- Prescribing more medication than necessary
- Ordering more laboratory tests than necessary

Abuse
- Billing for unnecessary medical services
- Billing for brand name drugs when generics are dispensed
- Charging excessively for services or supplies

In addition to contacting Phoenix Health Plans (HMO) you can also report fraud, waste, or abuse by:

  • Calling 1-800-MEDICARE
  • Reporting it to the Office of the Inspector General:
    • Online
    • By phone at 1-800-HHS-TIPS
      TTY users should call 1-800-377-4950

In addition to fraud, waste and abuse, you should also report if you feel there has been a breach of your personal health information per the Health Insurance Portability and Accountability Act (HIPAA).

HIPPA is a Federal law that helps prevent unauthorized access to protected health care information by setting rules and limits on who can look at and receive health information.

You can call the Compliance Hotline or contact us directly to report your concerns.

For additional information, visit the U.S. Department of Health & Human Services website.

H5985_023-2017 Pending Approval (Updated 9/30/16)