Reporting Fraud
Physicians Choice Advantage + Rx has set a high priority for prevention, detection and reporting of fraud, waste and abuse.
Fraud
Intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.
Examples:
- Billing for services the member did not receive.
- Member receives medical care using another person's medical I.D. card.
- A member who gives false information in order to get benefits.
Waste
Provider practices that are inconsistent with sound business, fiscal or medical practices that result in unnecessary costs to the Medicare and/or Medicaid programs.
Abuse
Reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. Physical abuse, sexual abuse, neglect or inappropriate treatment by a medical provider.
You may report any suspected fraud, waste and/or abuse by calling the Fraud, Waste and Abuse Hotline at 503-485-3228 or toll free 1-877-462-7931. You do not have to give us your name and all of the information is confidential.
For hearing impaired, please send information in writing to:
Confidential: Compliance Officer
Physicians Choice Advantage + Rx
PO Box 2777
Salem, OR 97308