Fraud is when someone knowingly does something wrong or dishonest in order to benefit himself or someone else. Abuse consists of behaviors or actions that are unnecessary and create waste and could be dangerous in a health care setting.
You must report fraud and abuse when you think it might be occurring. Some examples of health care fraud are:
- Not reporting all of your financial information or giving false information when you apply for benefits
- Allowing someone else to use your health insurance card
- Permanently living in another state while still receiving health benefits from Maryland
- Selling medicines or supplies given to you by your doctor
- Changing or forging prescriptions given to you by your doctor
Some examples of how providers might commit fraud and abuse are:
- Performing services that are not needed
- Billing for services that were never performed
- Billing numerous times for the same service
When someone is reported for possible fraud and abuse, MedStar Family Choice will perform an investigation. The results are reported to the Maryland Department of Health (MDH). MDH may perform its own investigation too. People who perform these activities or any other dishonest activity on purpose may lose their health benefits, be fined or jailed.
While MedStar Family Choice looks for possible fraud and abuse activities, we need your help to stop fraud and abuse. MedStar Family Choice has a strict non-retaliation policy. You do not need to give your name. However, if you choose to give us your name, you don't have to worry about anyone denying you service, removing you from the managed care organization or treating you in any way that would cause you or a family member from feeling that you did something wrong for reporting any incident. If you know of a situation that may involve fraud and abuse, please report it immediately by calling our Compliance Director at (410) 933-2283, Member Services at (888) 404-3549, or you may also call the Medstar Health Corporate Integrity Hotline at (877) 811-3411. Your report will remain confidential.
You may also call the HealthChoice Fraud hotline at 1-800-455-4521. Again, you do not have to give your name. You may also send something in writing to the MDH Program Integrity Unit, 201 West Preston Street, Baltimore, MD 21201.