What are fraud, waste, and abuse?

Fraud is the intentional deception or misrepresentation by a person for profit or to gain an unfair advantage.

Waste is the over utilization, underutilization, or misuse of resources.

Abuse is conduct inconsistent with fair, ethical, dental, business or fiscal practices and which could result in unnecessary costs and/or payments.

Examples

• Using someone else's identification card to get care;
• Concealing other insurance coverage;
• Billing for services not rendered;
• Billing for a service that is covered when a non-covered service was performed to gain payment;
• Altering service or treatment in claims submission to obtain benefit payment for a different, more expensive, treatment; and
• Altering the date of service to fall within eligibility;

Contact us immediately if you suspect fraud, waste, or abuse. You may remain anonymous or provide your contact information.