Fraud, Waste and Abuse: Detection, Prevention and Reporting
Preventing and correcting fraud, waste and abuse (FWA) in health care is essential to our success in the work we do. Fraud, waste and abuse can occur in many ways including:
- Altering an invoice or receipt to secure payment
- Billing for a more expensive service than provided
- Submitting a claim for medications or services not provided
- Falsifying a patient’s diagnosis to justify an unnecessary medical procedure
- Misrepresenting a procedure to secure payment for a non-covered procedure
- Billing multiple times for the same service
- Using another’s ID or insurance card without authorization
If you detect or suspect FWA, please report it immediately. Your report is confidential and prohibits retaliation against anyone for reporting in good faith a possible violation of the code, law or regulation.
Imperial Health Plan of California, Inc.
Attn: Compliance FWA
PO Box 60874
Pasadena, CA 91116
Our Compliance Department investigates reports and works with other departments in the company to ensure that all appropriate steps are taken to stop fraud, waste and abuse.