Fraud is defined as intentional deception or misrepresentation made by an entity or person, including but not limited to a subcontractor, vendor, provider, member or other customer with the knowledge that the deception could result in some unauthorized benefit to a person or an entity.
Some examples of fraud are –
Waste is defined as an act involving payment or the attempt to obtain payment for items or services where there was no intent to deceive or misrepresent, but where the outcome of poor or inefficient methods resulted in unnecessary costs to the plan.
Abuse is defined as incidents or practices that clash with accepted, sound business, fiscal, or medical administrative practices. Abuse may, directly or indirectly, result in unnecessary costs to the health plan, improper payment, or payment for services that fail to meet professional standards of care or are medically unnecessary.
Some examples of abuse are –
If you have reason to believe that fraud, waste or abuse has happened, you have a few reporting options. You do not need to give your name or contact information, and reports are kept confidential.
To report suspected fraud, waste and abuse, you can reach Unity Health Insurance’s Compliance department at –
You can also report –
*Note: While you may remain anonymous, in order to accept submissions for review by fax, the OIG Hotline requires a complaint to include a formal cover letter or the use of the downloadable complaint submission form, which is available online at oig.hhs.gov
View List of Summer 2017 Unity Communicator Articles
© 2017 Quartz Health Solutions, Inc. All rights reserved.
Quartz Health Solutions, Inc., Unity Health Plans Insurance Corporation, Gundersen Health Plan, Inc., Gundersen Health Plan Minnesota, Physicians Plus Insurance Corporation, Gundersen Health System, UnityPoint Health and UW Health are separate legal entities. Plans are underwritten by Unity Health Plans Insurance Corporation unless otherwise noted.