Healthcare Fraud, Waste & Abuse

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, and 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.

VIEW OR DOWNLOAD FRAUD, WASTE AND ABUSE

VIEW OR DOWNLOAD PROVIDER FRAUD, WASTE AND ABUSE TRAINING

VIEW OR DOWNLOAD LAWS AND REGULATIONS

VIEW OR DOWNLOAD FRAUD AND PREVENTION AND DETECTION PLAN

VIEW OR DOWNLOAD 2023 PROVIDER TRAINING ON DMEPOS

VIEW OR DOWNLOAD AUDIT PLAN SUPPLEMENTAL GUIDE

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

Delivery Code: FIPR
Highmark Wholecare
Attn: FWA/SIU Unit
120 Fifth Ave
Pittsburgh, PA 15222

Or call the Fraud Hotline at: 1-844-718-6400

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)