Fraud & Abuse


Fraud, Waste, and Abuse hurts everyone. 

It can even raise the cost of getting health care services. This is why we need help from our members and providers to find Fraud, Waste, or Abuse and stop it as soon as possible.

How YOU can help prevent Fraud, Waste and Abuse

As our Member, you play an important role in helping us find Fraud, Waste, or Abuse. If you feel that Fraud, Waste, or Abuse might be happening, report it as soon as you can. Here are some examples of possible fraud:

  • Someone pretends to be from Highmark Wholecare, Medicare or Social Security and asks for your Social Security number, bank account or credit card numbers, money, etc.
  • A health care provider offers you cash or gifts to get free medical care
  • A pharmacy bills you for drugs you did not get, or the pharmacy did not give you the right number of pills ordered by your doctor
  • You find out someone else is using your health insurance card
  • You are billed for health care services or items you did not get
  • Your doctor is ordering a lot of tests or items that you do not feel you need

Fraud, Waste and Abuse Definitions

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Provider Fraud, Waste and Abuse Training

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Laws and Regulations

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Fraud and Prevention and Detection Plan

View and download

If you suspect Fraud, Waste, or Abuse, call us at 412-255-4340 or 1-844-718-6400 (TTY Users can call 711 or 1-800-654-5984) so we may look into your concerns. 

Click here to use our on-line form to Report Suspected Fraud, Waste or Abuse.

You have the option to remain anonymous at all times. You do not have to give your name. Highmark Wholecare has a team of people who look into all calls or mail regarding possible Fraud, Waste, or Abuse of health care services.

To report Medicare or Medicaid Fraud or Abuse you may contact Highmark Wholecare by mail or phone at:

Highmark Wholecare
Attention: FWA/SIU Unit
Four Gateway Center, Suite 2100
444 Liberty Avenue
Pittsburgh, PA 15222

Or call the Fraud Hotline at: 412-255-4340 or 844-718-6400

You may also report to the Pennsylvania Department of Human Services (DHS) at:

Department of Human Services
Office of Administration
Bureau of Program Integrity
P.O. Box 2675
Harrisburg, PA 17105-2675

Or call 1-866-DHS-TIPS (1-866-379-8477)

You have the option to remain anonymous at all times.



This information is issued on behalf of Highmark Wholecare, coverage by Gateway Health Plan, which is an independent licensee of the Blue Cross Blue Shield Association. Highmark Wholecare serves a Medicaid plan to Blue Shield members in 13 counties in central Pennsylvania, as well as, to Blue Cross Blue Shield members in 27 counties in western Pennsylvania. Highmark Wholecare serves Medicare Dual Special Needs plans (D-SNP) to Blue Shield members in 14 counties in northeastern Pennsylvania, 12 counties in central Pennsylvania, 5 counties in southeastern Pennsylvania, and to Blue Cross Blue Shield members in 27 counties in western Pennsylvania.

Copyright 2022 by Highmark WholecareSM