What you should know
Fraud is the intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. It has been estimated that over $60 billion a year is lost to health care fraud schemes. Priority Partners wants YOU to join the fight to stop health care fraud by reporting suspicious activity
Some examples of health care fraud you may encounter are:
- A Provider billing for services they did not render or for products they did not provide
- A Provider billing for products or services that are not medically necessary
- A Patient selling prescription medicine or items intended only for that patient
- A Patient obtaining many prescriptions for the same drug from several doctors during the same time period
- Any individual forging or changing prescription forms
Priority Partners Special Investigations Unit (SIU) investigates allegations of 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 (including the examples cited above)
- Report lost or stolen medical assistance cards to Priority Partners Customer Service Department at 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. 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 concern of fraud, waste or abuse. 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 complaints. 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:
You can contact MDH by either of the following:
You can also report fraud to your local Department of Social Services.