Prevent Fraud
Prevent Fraud, Waste and Abuse

Help Prevent Fraud

Unity Health Insurance is committed to improving the health of the communities we serve. This includes financial health as well as physical. You can help us prevent health care fraud, waste and abuse ​the following ways. . . .

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 –

  • Forged or altered applications or enrollment forms
  • Filing false claims or claims for services not performed
  • Misuse of a member ID card
  • Enrolling an individual without consent

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 –

  • Billing for services that were not medically necessary
  • Over-charging for services or supplies
  • Misusing codes on a claim, such as upcoding or unbundling codes

How to report suspected fraud, waste and abuse

Report FraudIf 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 –

  • By visiting CMS’ State Contacts Database at cms.gov/apps/contacts
  • By contacting the Office of Inspector General’s (OIG) National Fraud Hotline –
    • Phone: 800.447.8477
    • Fax*: 800.223.8164
    • TTY:  800.377.4950
    • Visit OIG online at oig.hhs.gov

*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