Report fraud & abuse
These processes apply to your Medicare Advantage Plan administered by UnitedHealthcare effective January 1, 2021. For fraud, waste and abuse related to medical claims and services with dates of service prior to January 1, 2021, please contact your prior administrator.
Fraud and abuse takes place every day and may go unnoticed. That’s why the HealthSelectSM Medicare Advantage Plan (PPO) has a Fraud and Abuse program to identify and detect fraud and abuse. If you suspect that the plan, a health care professional or someone you know has been a victim of health care fraud, it’s important to report your concerns.
What is fraud? |
What is abuse? |
|---|---|
Fraud is when someone deliberately practices deceit in order to benefit from it. Some types of fraud are:
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Abuse is improper use of the benefits and/or services being provided. Some types of abuse are:
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What can I do to protect myself?
- Report suspicious billing
For claims questions, billing errors or provider disputes please call UnitedHealthcare customer service at (855) 853-0453, 7 a.m. – 7 p.m. CT, Monday through Friday, 7 a.m. – 3 p.m. CT Saturday. TTY users, call 711. - Review your policy and benefit statements
Review your policy, Explanation of Benefits (EOB) statements and any other paperwork you receive related to your health care coverage. Make sure you received the treatments for which your health plan was charged and question suspicious expenses. - Beware of "free" offers, including waiver of copay or coinsurance
Offers of "free" services, including waiver of copay or coinsurance , are often fraud schemes designed to bill you and your health plan illegally for thousands of dollars of treatments you never received. Do not give your policy number in exchange for getting a "free" consultation. - Protect your health plan ID card like your credit card
In the wrong hands, a health plan ID card is a license to steal. Don't give policy numbers to door-to-door salespeople or telephone solicitors. Never give your card to a friend to use for medical services.
How do I report fraud and abuse?
If you think you've been a victim of identity theft or fraud, call any of these numbers:
- Call toll-free 1-800-MEDICARE (1-800-633-4227). TTY, call toll-free 1-877-486-2048, 24 hours a day, 7 days a week.
- The Fraud Hotline of the HHS Office of Inspector General, toll-free at 1-800-HHS-TIPS (1-800-447-8477). TTY, call toll-free 1-800-377-4950. You can also email HHSTips@oig.hhs.gov.
- The Federal Trade Commission's ID Theft Hotline toll-free at 1-877-438-4338 to make a report. TTY users, call toll-free 1-866-653-4261.
You can always remain anonymous.
Other resources
- Review the Code of Federal Regulations
- Learn how to report Medicare fraud from the Centers for Medicare & Medicaid Services (CMS).
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