How Health Care Fraud Can Affect You!
University of Maryland Health Advantage is committed to ensure that its providers - doctors and other health care professionals - are reputable and are able to provide quality care. In addition, University of Maryland Health Advantage takes its responsibilities towards reducing cost, preventing waste, and uncovering potential fraud very seriously. That is because we empower all our employees and contractors to find, reduce, eliminate, or report fraud, waste, and abuse. However, there is always a possibility that a provider, or a consumer, will engage in unethical, potentially fraudulent practices. Even a single fraudulent claim can raise the cost of health care benefits for everyone.
What is health care fraud?
Health care fraud is a crime. Healthcare fraud means to deceive another, like a private insurer, by intentionally misrepresenting or concealing a material fact(s) in order to obtain money or property, such as health care coverage or benefits. Fraud takes many forms, and can include direct misrepresentations as well as half-truths and the knowing concealment of facts. Some examples of provider health care fraud are:
Health Care Fraud,Waste and Abuse can take many forms. Some common types of health care fraud, waste and abuse include:
Help avoid and prevent health care fraud.
Here are some easy ways you can protect yourself from health care fraud, and keep health care costs down for everyone.
Don't be a victim of identity theft.
If you think you've been a victim of identity theft or fraud:
Call any of these numbers:
University of Maryland Health Advantage is working to minimize health care fraud.
Our Special Investigations Unit (SIU) is responsible for minimizing University of Maryland Health Advantage's risk of health care fraud. The SIU partners with University of Maryland Health Advantage's and our contractors’ Member Services, Provider Network and Claim Departments to help identify suspicious claims, stop payments to fraudulent providers and punish wrongdoers.
The SIU also works with state and federal law enforcement, regulatory agencies and other insurance companies to detect and prevent health care fraud and assist in the pursuit of restitution and/or prosecution of health care fraud offenders.
How to report potential cases of fraud
To report a potential case of fraud, call University of Maryland Health Advantage’s dedicated compliance line at (410) 779-9323, 24 hours a day, 7 days a week. TTY users may call 711.
This hotline allows you to report cases anonymously and confidentially. University of Maryland Health Advantage will make every effort to maintain your confidentiality. However, if law enforcement needs to get involved, University of Maryland Health Advantage may not be able to guarantee your confidentiality. Please know that University of Maryland Health Advantage will not take any action against you for reporting a potential fraud case in good faith.
You can also email us at Compliance@ummshealthplans.com or write to us at:
University of Maryland Health Advantage
1966 Greenspring Drive, Suite 600
Timonium, Maryland 21093.
For potential medical or non-prescription fraud cases, you may report to the Medicare program directly, toll-free, at 1-800-Medicare (1-800-633-4227). The Medicare fax number is 1-717-975-4442 and the website is www.medicare.gov.
For more information, request the guide titled “Protecting Medicare and You from Fraud” by calling toll-free 1-800-Medicare (1-800-633-4227). TTY/TDD users should call toll-free 1-877-486-2048. A customer service representative can answer your questions 24 hours a day, 7 days a week.