Fraud, Waste, and Abuse

Reporting suspected Fraud, Waste, and Abuse

It is in your best interest to prevent and detect FWA by reporting suspected individuals, entities, and activities. Central Health Plan of California is committed to detecting and preventing health care fraud, waste, and abuse. Central Health Plan takes all allegations of fraud, waste, abuse or other compliance issues very seriously.

If you suspect fraud, waste, or abuse, report to Central Health Plan through:

Individuals wishing to report a suspicious incident may identify themselves, or remain anonymous.
Thank you for helping us fight fraud, waste, and abuse!

What You Can Do To Stop Fraud, Waste, and Abuse

Health care fraud, waste, and abuse (FWA) cost taxpayers billions of dollars each year. You can help stop fraud, waste, and abuse by reporting it. Some examples of FWA are:

• Using someone else’s ID card to get a service or product
• Doctors billing for a service not performed, or billing for a service or product that is not needed
• Getting drugs for someone else using a health plan ID or drug card
• Using someone else’s medical benefits for health care services.
• Using someone else’s social security number to qualify for government assistance.
• Billing from the doctor for services that did not occur.
• Prescribing more medication than is medically necessary.
• Providing health care services more than is medically necessary.
• Requesting and obtaining unnecessary medications or medical equipment

How does fraud, waste, and abuse affect you?

If someone files a claim in your name for a service you did not receive, they are altering your health care history with false information.

This false information could:

• Affect your future ability to obtain life or health insurance
• Affect the health care you receive from other providers
  • False information results in inappropriate care/treatment
  • The wrong prescribing medication could be prescribed resulting in an adverse drug reaction
  • Unnecessary or harmful procedures
  • Wrong blood transfused
  • Vaccination record inaccurate
• Exhaust your health insurance benefits
• Cause a denial of coverage due to “pre-existing conditions” of the thief
• Cause you to receive calls from collection agencies
• Cause your credit rating to be adversely affected
• Cause you to experience lost opportunities

Preventing health care fraud, waste, and abuse

Central Health Plan members may be the first line of defense to prevent and identify health care fraud, waste, and abuse. Below are some important tips to keep in mind:

• Don’t give out your medical information to anyone but your doctor, clinic or hospital.
• Do guard your medical ID card and information as you would your wallet.
• Don’t let others get free medical services or equipment by using your medical ID card.
• Do be cautious of anyone who asks you to use your medical ID card.
• Don’t sign your name to a blank form.
• Do ask for a copy of any forms you sign.