Fraud & Waste – How To Identify And Report It
Healthy Way LA » Member Handbook » Fraud & Waste – How To Identify And Report It
| Fraud |
| Fraud includes, but is not limited to, using someone else’s medical benefits for your health care services, using someone else’s social security number to qualify for government assistance or giving untrue information or using fake documents to support an application for HWLA. If you commit fraud you may lose your HWLA coverage.
Other people can commit fraud too. That includes when a doctor bills for services that were not provided, or a pharmacy claims for a different drug than the one it gave to the patient. |
| Waste |
Waste is the planned use, throwing away, or spending of health care or government resources in an unwise and wrong manner. Examples of waste include:
- Prescribing more medication than is medically necessary
- Providing more health care services than are medically necessary
|
| How To Report Fraud And Waste |
| If you suspect someone of using your information or committing fraud, waste or abuse, please call Member Services. This number is available 24 hours a day, seven (7) days a week. |
| Why Should You Care About Fraud, Waste And Abuse? |
| Health care fraud, waste and abuse are serious issues. Fraudulently received benefits or services impact the cost of your health care services. The cost of health care impacts the benefits available to you. |
| Preventing Health Care Fraud |
Here are a few helpful tips on how you can help prevent health care fraud:
- Do not give your ID card or ID card number to anyone except your doctor, medical home, hospital, health care provider, the Nurse Advice Line, or Member Services.
- Do not let anyone borrow your ID card.
- Never loan your social security card to anyone.
Beware of anyone who offers you free medical services in exchange for your ID card. You should never give away your ID card to anyone in exchange for free medical services. |
