You Can Make a Difference - Report Suspected Fraud

Did You Know?

• Health care fraud is contributing to the rising cost of health insurance.
• Health care fraud reduces the amount of funds available to pay honest providers.
• Health care fraud increases premiums to employers and members.
• Health Net will investigate allegations of fraud, waste and abuse – and reports of non-compliance on any level.
• Health Net's Special Investigations Unit is available as a resource to Health Net employees, members and providers, as well as to Health Net's delegates – first tier, downstream, and related entities.
• See below for examples of fraud and more.

How to Report

Health Net's Fraud hotline and Integrity hotline are available 24/7, and callers may choose to remain anonymous.

• Health Net Fraud Hotline: 1-800-977-3565
• Health Net Integrity Hotline: 1-888-866-1366

What to include in your report:

1. Unless you choose to remain anonymous, please provide your name, telephone number, address, and email address. If you are submitting your report anonymously, please take care to withhold personally identifiable information.
2. Explain the nature, scope and time frame of the activity in question.
3. Explain how you are aware of the alleged activity.
4. Specify if you know of any potential witnesses to the activity.
5. Provide any documents or other physical evidence in your possession.
6. For more information, please reference Centene Corporation Business Ethics and Conduct Policy (pdf).

Fraud Awareness Tips

The following links explain common fraud schemes that could impact members.

• Genetic Testing (pdf)
• Charging for Prescriptions (pdf)
• Open Enrollment Identity Theft (pdf)
• Before You Change Coverage (pdf)
• Email Scams (pdf)
• Prescription Drug Abuse and Misuse (pdf)
• Discount Prescription Drug Card Scams (pdf)
• Telemarketing Scams (pdf)
• Risks Associated with Online Pharmacies (pdf)
• Home Health Fraud (pdf)
• Medical Transportation Fraud (pdf)
• Health Insurance Marketplace Fraud (pdf)
• Questioning Free Medical Supplies (pdf) English | Spanish
• Services Not Provided (pdf) English | Spanish
• Identify Theft Prevention Tips (pdf) English | Spanish
• Other Fraud Considerations (pdf) English | Spanish

The following links address other important matters.

• Prescriber Enrollment (pdf)
• How to Dispose of Medicine Properly (pdf)

Examples of Fraud and Non-Compliance

*As of July 1, 2011, Centers for Medicare & Medicaid Services identified these five counties as most at risk for high incidences of fraud, waste and abuse.