What you should know
It has been estimated that over $60 billion a year is spent on health care fraud. Priority Partners wants to find and stop health care fraud. Fraud is any dishonest act that a person commits, or commits on behalf of someone else, which results in benefits that he or she is not entitled to.
Some examples of health care fraud are:
- Using someone else’s medical assistance card or medical assistance number to get health care services
- Loaning your medical assistance card to another person so that they can receive health care services
- 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 prescription medicine or items provided to you under the medical assistance program
- Obtaining 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 actual and suspected health care fraud. The results are then reported to the Maryland Department of Health (MDH). The MDH may perform its own investigation and take 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
- Report lost or stolen medical assistance cards to Priority Partners Customer Service Department at 1-800-654-9728
Remember health care fraud affects everyone.
If you believe someone is committing fraud against Priority Partners or the Maryland Medical Assistance Program, please report the act to Priority Partners, the MDH, or the Department of Social Services. You can remain nameless, and all reports of fraud are kept confidential. Priority Partners is committed to following all applicable laws and regulations, in particular those that address health care fraud, waste and abuse, and the improper billing of health care services.
What happens to me if I report a concern?
Priority Partners takes its responsibility to protect your “right to report” seriously! No Priority Partners employee may threaten, coerce, harass, retaliate, or discriminate against any individual who reports a compliance concern. To support this effort, the Health Plan has enacted zero-tolerance policies and annually trains all personnel on their obligation to uphold the highest integrity when handling compliance related matters. Any individual who reports a compliance concern has the right to remain nameless and Priority Partners commits to enforcing this right!
How can I report fraud?
Reporting is simple! You may report through the Managed Care Organization (MCO), Maryland Department of Health (MDH), or the Department of Social Services (DSS).
You can contact Priority Partners Compliance Department by either of the following:
Write: JHHC Program and Payment Integrity
Attention: Fraud, Waste and Abuse
7231 Parkway Drive
Hanover, MD 21076
You can contact MDH by either of the following:
Call: Call MDH directly at 1-800-284-4510 or the Inspector General at 1-866-770-7175
Write: MDH Program Integrity Unit, 201 West Preston Street, Baltimore, Maryland 21201
You can also report fraud to your local Department of Social Services.