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Protecting yourself against fraud, waste, and abuse


What is Fraud, Waste, and Abuse?

Fraud is generally defined as making a false claim in an effort to receive payment. For example, fraud in the healthcare industry can involve:

  • Billing for medical services that weren’t ordered or provided
  • Billing for durable medical equipment items that weren’t ordered or provided
  • Providing services or items a person doesn’t need based on his or her medical history
  • “Doctor shopping” – when a patient who may or may not have a legitimate physical ailment goes from doctor to doctor to obtain multiple prescriptions for narcotic painkillers

You are one of the first lines of defense against Medicare fraud - take action to protect your Medicare benefits!

Report services or items that you have been billed for but did not receive

  • Refuse medical supplies you did not order
  • Return unordered medical supplies that are shipped to your home
  • Report companies that send you these items

Review your medical statements

  • Make sure you receive the services or items billed
  • Check the number of services billed
  • Ensure that the same service has not been billed more than once

Protect your identity and benefits

  • Never give out your Social Security, Medicare, health plan numbers, or banking information to someone you don’t know
  • Carefully review your Plan Statement to ensure all the information is correct
  • Know that free services DO NOT require you to give your plan or Medicare number to anyone

Be on the lookout for fraudulent schemes such as:

  • People using your Medicare or health plan member number for reimbursements of services you never received
  • People calling you to ask for your Medicare or health plan numbers
  • People trying to bribe you to use a doctor you don’t know to get services you may not need

You can report potential compliance issues and/or issues with fraud, waste and abuse to Golden State medicare Health Plan’s Compliance Officer.

Erin Ramsey

(562)799-0870

compliance@gsmhp.com

For anonymous reporting please mail concerns to:

Golden State Medicare Health Plan
C/O Erin Ramsey
P.O. Box 2362 Cypress, CA 90630

Golden State Medicare Health Plan has a policy of non-intimidation and non-retaliation for good faith reporting of compliance concerns.