Fraud, Waste and Abuse costs taxpayers billions of dollars each year and can put your health and welfare at risk. Healthcare fraud can increase the cost of prescription drugs as well as Part D plan expenses, such as premiums and amounts you pay out-of-pocket. Members Health Insurance Company (MHI) is committed to detecting, preventing and reporting healthcare fraud, waste and abuse.
What is Fraud, Waste and Abuse?
Fraud is knowingly and willingly misrepresenting or deceiving a healthcare program for the purpose of receiving money or services not owed.
Waste is the overutilization of services that, directly or indirectly, results in unnecessary costs to the healthcare program.
Abuse is an action that may, directly or indirectly, results in unnecessary costs to the healthcare program.
How to Prevent Fraud, Waste and Abuse
Medicare and health plan fraud can happen in a number of ways. You play a vital role in protecting the Medicare program and your Members Health Insurance Company Part D plan program.
Here’s how you can help:
Protect your Medicare number
- Never allow another person to use your Medicare number and never use someone else's Medicare number.
- Only give your Medicare number to your doctors and other healthcare providers.
Protect your Part D plan idetification number
- Never allow another person to use your Part D plan identification number to obtain prescription drugs.
- Only give your Part D plan identification number to your pharmacy.
Help prevent others from committing fraud
- Make sure a provider does not bill for services or prescriptions that you did not receive.
- When a provider tells you equipment or services are, they don't need your Medicare number.
- Review your Medicare Summary Notices and Monthly Prescription Drug Summary to make sure the services billed are correct.
- Make sure you only pay providers for the amount Medicare says you owe.
Report other types of healthcare fraud
- Providers billing for services not rendered.
- Providers falsifying your medical records to obtain payment for services that may not be covered, such as cosmetic services that are not medically necessary.
- Be suspicious when a provider tells you they know how to get Medicare or the health plan to pay for their services.
How to Report Fraud, Waste and Abuse
If you suspect or witness healthcare fraud, you should immediately report it to the Compliance Department of Members Health Insurance Company.
Reporting to Members Health Insurance Company:
Email the MHI Compliance Department: PartDCompliance@fbhealthplans.com
Medicare Compliance Officer
Compliance Department Location:
Members Health Insurance Company
147 Bear Creek Pike
Columbia, TN 38401
Anonymous MHI Compliance Hotline:
Online Reporting: www.fbhealthplans.ethicspoint.com
All calls are confidential to the greatest extent possible. The caller’s identity will remain anonymous if desired.
To permit adequate information, all anonymous reports, either written or submitted via the Hotline, should contain the following information:
- Date, time and place of incident;
- Names of the individual(s) involved, if known;
- Pertinent facts; and
- Reason(s) why the person filing the report believes the incident raises compliance concerns.