Fraud Prevention

 

Fraud Prevention - A Team Effort:

In an effort to prevent fraud and abuse, IEHP encourages Providers and their staff to report any suspicious circumstances when they arise. You may want to ask for another form of identification in addition to the IEHP card. Identification with both a picture and a signature, such a valid driver's license or State identification card, are suggested. We are informing Members of this concern and are requesting that they have additional identification available when they come to you. 

 

Fraud Prevention and Reporting: 

IEHP has adopted and maintains a Fraud, Waste and Abuse program in compliance with Federal and State laws. as part of this program, IEHP expects Providers to also have their own program in place to prevent, detect and resolve suspected fraudulent behavior. To contact the IEHP Compliance Department to report suspected fraud, waste and/or abuse, write, E-mail or fax as follows: 

Write: IEHP Compliance Officer
P.O. Box 1800 Rancho Cucamonga,CA 91729-1800 

E-Mail: compliance@iehp.org 

Toll Free: (866) 355-9038

Fax: (909) 477-8536 

All information will be kept confidential to the extent possible as allowed by law.

To obtain more compliance guidelines, the Department of Health and Human Services (HHS) offers assistance at the following http://www.oig.hhs.gov/fraud.asp

FAQ: 

What are some common schemes of fraud?

PROVIDERS
  • Billing for services not rendered 
  • Paying a "kickback" in exchange for a referral for medical services or goods 
  • Unbundling 
  • Overcharging for services or goods 
  • Using false credentials 

MEMBERS
  • Allowing unauthorized individuals to use ID Card to obtain benefits 
  • Altering prescriptions 
  • Falsifying residence information to obtain benefits 

What do I do if I suspect an IEHP Member is engaging in possible fraud?

First, document your suspicions. Then, contact IEHP directly and explain the case to one of our Representatives. At times, IEHP may request additional information that is necessary to investigate the case. Thus, Provider documentation is strongly encouraged. You may also submit a 

Fraud Report Form along with supporting documents to IEHP. If you have any questions, please contact your IEHP Provider Service Representative.

What do I do if my facility has made some billing errors?
If you suspect that errors in billing may have occurred, contact your IEHP Provider Services Representative at (909) 890-2054.

What are some other things I can do as a Provider?
  • Periodically perform internal audits of billing practices and compare billing records with payments received. 
  • Do not leave prescription pads, which include a Provider's identification and license number, out in the open. For example, do not store prescription pads in examining room cabinets of leave on office counters. 
Contacting the OIG  The OIG is there to assist you and maintains a hotline, which offers a confidential means for reporting vital information. For information on confidentiality, please contact the hotline and ask about our confidentiality source program. Each caller is encouraged to assist the OIG by providing information on how they can be contacted for additional information but CALLER MAY REMAIN ANONYMOUS. 

 

HOTLINES:

By Phone: 1-800-HHS-TIPS (1-800-447-8477)
By E-Mail: Htips@oc.dhhs.gov

Additional Hotlines
DHS MEDI-CAL FRAUD HOTLINE:
By Phone: 1-800-822-6222

The recorded message may be heard in English and four other languages: Spanish, Vietnamese, Cambodian, and Russian. The call is free and the caller may remain anonymous.
By E-Mail: stopmedicalfraud@dhs.ca.gov

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