Fraud, Waste and Abuse
What is Fraud, Waste and Abuse?
Fraud, Waste and Abuse is a serious problem in health care requiring your attention. Anyone can commit healthcare fraud.
- Fraud is knowingly and willfully performing, or attempting to perform, a scheme to take advantage of any health care benefit program. Obtain by means of false or deceitful pretenses any of the money or property owned by, or under the custody or control of, any health care program.
- Waste is an overuse of services or other practices that result in excessive cost.
Waste is usually caused by a mistake rather than unlawful actions.
- Abuse is an action that results in greater costs. Examples may include improper payment,
payment for services that fail to meet standards of care, or services that are not medically necessary.
How does Fraud, Waste and Abuse affect you?
Recent studies show that an estimated 60 billion dollars a year are lost to health care fraud in the United States. Most doctors are honest but there are a few doctors who abuse the system. This can cost taxpayers billions of dollars. This can put your health and wellbeing at risk. Health care fraud, waste and abuse affects by you having to pay higher co-payments and/or premiums. This means more money coming out of your pocket.
Examples of Fraud, Waste or Abuse
- Doctors billing for services not rendered.
- Members selling their prescription drugs.
- Brokers selling nonexistent policies.
- An unauthorized person using a members' ID card or a member loaning their ID card to someone to use it.
- Doctors changing medical records.
- Members receive a different drug than the doctor prescribed.
- Doctors performing services that are not necessary.
- Members giving false information on applications.
- A booth at the fair taking samples and billing your insurance.
- Telephone or door-to-door medical equipment sales.
- Insurance company giving away free meals while trying to sell you their plan.
How to help Trillium fight Fraud, Waste and Abuse
Help us fight Fraud, Waste and Abuse. Look over your benefit information when you receive it in the mail. By reviewing the information you can verify that the services listed are the services you received. If you see anything suspicious please report it. If you suspect health care Fraud, Waste or Abuse you can do the following:
- Call the Fraud, Waste & Abuse Hotline toll free 1-866-685-8664.
- You may also report to the Oregon Department of Justice by calling
(877) 877-9392 or online at www.oregonconsumer.gov.
- You may also contact the Centers for Medicare & Medicaid Services (CMS) at (800) 633-4227, TTY: (877) 486-2048.
All calls and information received by Trillium are handled confidentially.
Contact us for more information:
Confidential Compliance Hotline: Toll Free 1-866-685-8664.
The Trillium Compliance Hotline is available 24/7. All callers may choose to remain anonymous.
Trillium Community Health Plan
P.O. Box 11756
Eugene, OR 97440-3956