Report fraud, waste, or abuse
Health care fraud is a crime that has a big impact on the health care system. Both members and health care providers can commit health care fraud.
The cost of fraud, waste, and abuse was more than $3 trillion in 2014, according to the National Health Care Anti-Fraud Association (NHCAA).
Call: PerformCare Fraud Tip Hotline at 1-866-833-9718.
Mail: Special Investigations Unit, 200 Stevens Drive, Philadelphia, PA 19113
MA Provider Compliance Hotline at 1-866-379-8477.
Pennsylvania Department of Human Services' Bureau of Program Integrity.
Why should I care about fraud, waste, and abuse?
Fraud, waste, and abuse affect both health plan members and health care providers. They can:
- Affect the behavioral health services you receive.
- Raise your taxes.
- Keep providers from being paid for services.
- Contribute to rising health care costs.
In addition, health care fraud is a real crime with real consequences. It could lead to fines or even jail time.
What are fraud, waste, and abuse?
Fraud is a false statement from someone who knows that the statement is false.
- Example: Sam's doctor provides a service to him that he knows won't be covered. Sam's doctor says that he provided a covered service instead.
Waste is when someone uses a service more than they need to.
- Example: Rachel asks 2 different doctors to give her the same medicine. She now has more medicine than she needs.
Abuse may not be intentional. Abuse can lead to extra health care costs or losses to the health care system.
- Example: Jonathan's doctor sends him to get an X-ray when he does not really need one.
Remember: Report health care fraud to the PerformCare Fraud Tip Hotline at 1-866-833-9718.