Doctors HealthCare Plans, Inc. Your Health, Our Commitment
 2020 Ponce de Leon Blvd, Suite PH 1, Coral Gables, FL 33134   
  

Learn more about Fraud, Waste & Abuse

As part of our continued efforts to improve the quality of the healthcare services provided to our members, Doctors HealthCare Plans, Inc. (DHCP) has made a commitment to detect, prevent and deter Fraud, Waste and Abuse (FWA). 

What is Fraud, Waste & Abuse?
Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any healthcare benefit program or to obtain any of the money or property owned by, or under the custody or control of, any healthcare benefit program.

Waste is overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the healthcare system, including the Medicare and Medicaid programs. It is not generally considered to be caused by criminally negligent actions, but by the misuse of resources.

Abuse includes actions that may, directly or indirectly, result in unnecessary costs to the Medicare program, improper payment, payment for services that fail to meet professionally recognized standards of care, or services that are medically unnecessary. Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowing and/or intentionally misrepresented facts to obtain payment.

How to Report Fraud, Waste & Abuse

If you suspect fraud, waste or abuse, please report it to us and it will be investigated by the Special Investigation Unit.

To report suspected fraud, waste or abuse, you can contact us by: 

  • Phone: English / Spanish: (833) DHCP 911 or (833) 342 7911
  • Fax: (786) 628 2600
  • E-mail: reportfraud@doctorshcp.com
  • Mail: Doctors HealthCare Plans, Inc., Attn: Special Investigation Unit, 2020 Ponce de Leon, Blvd, PH 1, Coral Gables, FL 33134

You have the option to remain anonymous. All information received by the Special Investigations Unit (SIU) will be treated as confidential, and reporting if needed to state and federal authorities.

Help in the fight against Fraud, Waste & Abuse
Doctors HealthCare Plans, Inc. strives to maintain its employees, providers, vendors and members alert and informed on the fight against fraud, waste and abuse. We have developed a Code of Conduct, a Provider Manual, Policies and Procedures and other documents to assist in the fight.

For more information on preventing, detecting, and reporting fraud and abuse, as well as other Medicare and Medicaid information, refer to the resources listed below:

Resource Website
CMS Fraud and Abuse Educational Products https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-Products.pdf
CMS Fraud Prevention Toolkit https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/FraudPreventionToolkit.html
CMS National Training Program Resources https://cmsnationaltrainingprogram.cms.gov/resources
Can Someone Change my CPT Codes?

https://www.medscape.com/viewarticle/872465

Note: To access this article, you need to create a free account.

Center for Program Integrity: Protecting the Medicare & Medicaid Programs from Fraud, Waste, & Abuse

https://www.cms.gov/About-CMS/Components/CPI/CPI-Landing.html

Help Fight Medicare Fraud https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud
How to Report Medicare Fraud https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud/how-report-medicare-fraud
How to Report Medicaid Fraud
https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/FraudAbuseforConsumers/Report_Fraud_and_Suspected_Fraud.html
Medicaid Program Integrity Education https://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaid-integrity-education/edmic-landing.html
MLN Provider Compliance https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ProviderCompliance.html
OIG Advisory Opinions https://oig.hhs.gov/compliance/compliance-resource-portal/
OIG Compliance 101 https://oig.hhs.gov/compliance/compliance-resource-portal/
OIG Contact Information https://oig.hhs.gov/contact-us/
OIG Fraud Information https://oig.hhs.gov/fraud/
Physician Self-Referral https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/

The Basics of Medicare Web-Based Training (WBT) Series:

  • Part One: History, program overview, enrollment
  • Part Two: Billing, reimbursement, appeals
  • Part Three: Claim review programs, fraud and abuse, outreach and education
https://learner.mlnlms.com/Default.aspx

 

New Medicare Card

Medicare has completed mailing of new Medicare cards to all U.S. states and territories. The new Medicare cards have a new Medicare Number that’s unique to you, instead of your Social Security Number (SSN). This new number is called the Medicare Beneficiary Identifier (MBI). The MBI has 11 characters and is randomly generated. The MBI is composed of numbers and upper-case letters. The biggest reason Medicare took the SSN off of Medicare cards is to fight medical identity theft for people with Medicare.
Read more about the new cards and how to protect them

English: (PDF)
Spanish: (PDF)

 

 

H4140_FWA_C
Last Updated:  09/13/2019

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