• What is 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, result 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.

  • How do I report suspected fraud?
    What looks like fraud is usually a billing error, but it never hurts to check.

    If you suspect Medicare fraud, call Customer Service at 1-800-942-0247 (TTY 7-1-1) from 8 a.m. to 8 p.m., seven days a week.

    If you suspect Medicaid fraud, call Customer Service at 1-800-440-1561 (TTY 7-1-1) from 8 a.m. to 5 p.m., Monday-Friday.

  • What can I do to avoid or prevent health care fraud?

    • Protect your health insurance ID card like you would a credit card. Be careful about disclosing your insurance information. If you lose your insurance ID card, report it to us immediately.

    • If you are a Medicare member, be sure to compare your bill to your EOB.

    • If you suspect you may be a victim of health insurance fraud, report it immediately.

    • Be informed about the health care services you receive, keep good records of your medical care, and review all medical bills you receive. 

    • Shred your medical bills and records when you dispose of them.

    • Beware of "free" offers. Offers of free health care services, tests, or treatments are often fraud schemes designed to bill you and your insurance company illegally for treatments you never received.

  • Can I report fraud anonymously?
    Yes. When you report health care fraud to CHPW, any personal information you provide will stay confidential. You may also choose not disclose your personal information when completing the form.
  • I keep getting suspicious phone calls asking for my health care and/or personal information. What do I do? 

      When people claim to be from a trustworthy entity or group in order to get personal information, they are committing what is known as a phishing scam. Phishing tries to obtain information like credit card details, Social Security numbers, and health information to use in fraudulent activity or theft.

      CHPW will never ask you for your username, password, Social Security number, or financial information. We will never threaten to cancel your coverage if you do not supply us with information.

      Here are some ways to protect yourself from phishing scams:

    • • Do not give your personal information to anyone who calls or emails you unrelated to an inquiry you made.
    • • Proceed with caution - do not make any decisions before investigating the details.
    • • Never email personal or financial information unless it is secure.
    • • Safeguard your member ID card at all times. Do not give information on your member ID card to anyone other than your doctor, hospital or pharmacy.
  • I think I may be a victim of ID theft. What do I do?

    • • Make a report to your local sheriff or police department. Make sure to keep a copy of the police report for your records.
    • • Report it to the Federal Trade Commission's Identity Theft Hotline: 1-877-IDTHEFT (1-877-438-4338).
    • • Fill out the Report Potential Fraud Form and submit it to Community Health Plan of Washington.
  • Where can I learn more about health care fraud, waste and abuse?

    There are many anti-fraud resources available to you, but we recommend the following: 

    National Health Care Anti-Fraud Association (NHCAA)

    Medicare.gov

    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 

    Health Care Authority – Medicaid Fraud Prevention