Fraud Waste Abuse

What is Fraud, Waste and Abuse?

Fraud: Intentional deception or misrepresentation to obtain the money or property of a health care benefit program (by means of false or fraudulent pretenses, representations, or promises).

Waste: The over-utilization of services or other practices that result in unnecessary costs.

Abuse: Obtaining payment for items or services when there is no legal entitlement to that payment, but without knowing and/or intentional misrepresentation of facts to obtain payments.

What can you do to help prevent, report, and stop Fraud, Waste, and Abuse?

Report potential fraud:

The Provider Partners Health Plans Compliance Hotline 1-833-213-0636 is available 24 hours a day/7 days per week to our employees, members, providers and FDRs. The hotline allows for anonymous reporting of potential non-compliance and FWA matters. We also maintain a Compliance email address: compliance@pphealthplan.com.

• Medicare Fraud Hotline of the HHS office Inspector General: 1-800-HHS-TIPS (1-800-447-8477). TTY: 1-800-377-4950
• HHSC/OIG Inspector General: (800) 436-6184
• Web: https://oig.hhs.gov/
• Provider Partners Health Plans HMO SNP: (833) 213-0636
• https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse