Health insurance and prescription drug fraud and abuse costs billions of dollars each year and affects all of us by raising the cost of health care and health insurance premiums. Detecting and reporting fraud, waste and abuse is an important part of Physicians United Plan’s fraud and abuse program, and we need your help.

1. Always review your bills, claim forms and “Explanation of Benefits” (EOB) statements.
Ask yourself the following questions:

• Did I receive the treatment, product or prescription drug listed?
  
  
• Was the treatment or product, to the best of my knowledge, relevant to my condition? Your doctor should be willing to answer any questions you may have.
  
  
• Has this treatment or product been billed before? Billing twice for the same service may be a simple clerical error, but may also be a deliberate attempt to defraud you and Physicians United Plan.
  
  

2. Protect your member ID card and number. If you lend your card to someone else to use, you are committing fraud. Report lost or stolen ID card to Physicians United Plan as soon as possible. Someone could use your ID number to bill for services you didn’t receive.

3. If you have a question or concern about a bill, a procedure or diagnosis, contact your provider as there may have been a clerical error or misunderstanding. If this does not resolve the issue, you may report your concern to our Customer Service telephone number listed on your ID card. Or you may call our toll-free Hotline 1-866-461-5705 and make an anonymous report. Or use the form provided below to send us a report.

4. The Centers for Medicare and Medicaid Services, the federal government agency that oversees the Medicare Advantage program, has contracted with a Medicare Integrity Contractor (MEDIC) to monitor complaints and conduct fraud investigations concerning Prescription drugs. You may report potential fraud, waste or abuse pertaining to your prescription drug benefit to the MEDIC at 1-877-772-3379. Or visit their website at www.healthintergrity.org The website also includes a fraud complaint referral form that you may find useful.

• Someone pretends to represent Medicare or Social Security and asks you for your Medicare or Social Security number, bank account or credit card information.
• Someone asked you to sell your Medicare plan ID card.
• Someone offered you cash or a gift worth more than $15 to sign up for a Medicare plan.
• You were encouraged to disenroll from your plan.
• Your pharmacy did not give you all your drugs, you were billed for drugs that you didn’t receive or you received a different drug than your doctor ordered.
• Someone asked you to get drugs for them using your ID card.
• Your Medicare plan did not pay for your covered drugs

Physicians United Plan will not tolerate fraud. Feel free to call our 24-hour toll-free Hotline: 1-866-461-5705