You can help prevent health care fraud.
The National Health Care Anti-Fraud Association estimates that the financial losses from health care fraud are about $100 million per day.
Community Health Plan of Washington is committed to doing all we can to prevent, detect, and correct health care fraud.
When you report a situation that may be potential health care fraud, you’re doing your part to help save money for the health care system.
What is health care fraud, waste, and abuse?
Fraud occurs when someone knowingly and willfully submits a false claim that results in inappropriate payments.
Waste is overuse of services or other practices that, directly or indirectly, results in unnecessary medical costs. It is not generally considered to be caused by criminally negligent actions, but by the misuse of resources.
Abuse is an action that may result in unnecessary medical costs. It’s when a person or entity has not knowingly and/or purposely misrepresented facts to obtain payment.
Examples of Fraud, Waste, and Abuse
If you still have questions about health care fraud, waste, or abuse, please read our Frequently Asked Questions page or refer to the resources below:
- National Health Care Anti-Fraud Association (NHCAA)
- Health Care Authority – Medicaid Fraud Prevention
- HHS Office of Inspector General
- Phone: 1-800-HHS-TIPS (1-800-447-8477) or TTY 1-800-377-4950
- Fax: 1-800-223-8164
Report potential fraud
You can submit a Potential Fraud Report to CHPW via email, fax, or mail using contact information on the form.
You can also call the Compliance Hotline and report potential fraud anonymously: 1-800-826-6762