Priority Partners
wants to find and stop health care fraud among its members. Fraud
is any dishonest act that results in a benefit to the person doing
the act or someone else that he or she is not entitled to. Some
examples of health care fraud are:
-
Using someone
else’s medical assistance card to get health care services.
-
Loaning your
medical assistance card to another person so that they can
receive health care services.
-
Using tricks or
scams to get someone else’s medical assistance number.
-
Using someone
else’s name, social security number, or other personal
information to be eligible for the medical assistance program.
-
Hiding income
and assets to qualify for the medical assistance program.
-
Living in
another state while getting Maryland medical assistance
benefits.
-
Selling items
provided to you under the medical assistance program.
-
Selling
prescription medicine.
-
Getting many
prescriptions for the same drug from several doctors during the
same time period.
-
Forging or
changing prescription forms.
Priority Partners’ Compliance Department investigates charges of
health care fraud. These are then reported to the Maryland
Department of Health and Mental Hygiene (DHMH). DHMH may perform
its own fraud investigation, and takes action against people who are
found to have committed fraud.
How Can I Help?
You can help reduce
health care fraud by following these simple rules:
-
Never loan your medical assistance card to anyone.
-
Guard your medical assistance number as you would your
social security number.
-
Follow all medical assistance rules.
-
Report all suspicions of fraud.
What Should I do if I Know or Suspect that Someone has Committed
Fraud?
If you know or suspect that someone has committed health care fraud,
you should report it immediately. There are several ways to report
fraud:
-
To report to Priority Partners
-
To report to DHMH
-
Contact your local Department of Social
Services
Health care fraud affects everyone, especially those of you who
receive care. If you believe someone is cheating Priority
Partners or the Maryland Medical Assistance Program, please
report the act to DHMH or the Department of Social Services. You
can remain nameless, and all fraud reports are kept
confidential.
