Help in the fight against Healthcare Fraud and Abuse

Every year billions of taxpayer dollars vanish to health care fraud and abuse. It is the number one threat to Medicare, Medi-Cal and our health system as a whole. Those breaking the law could be physicians, patients, laboratories, hospitals, employees or vendors, providers or billing services used by the providers. Fraud and abuse appears in various different forms, including, but not limited to, falsifying medical records, billing for services not provided, "up coding" or listing a fraudulent diagnose, improperly waiving copayments and/or deductibles or kick-backs.

The government defines fraud and abuse as:

• Fraud is an intentional deception or misrepresentation made with the knowledge that the deception could result in an unauthorized benefit.

• Abuse any incident or practice of a provider, physician, supplier which, although not usually considered fraudulent is inconsistent with accepted and sound medical, business or fiscal practices and directly or indirectly results in unnecessary costs to the Medicare program, improper reimbursement, or program reimbursement for services that fail to meet professionally recognized standards of care or, in some cases, may be medically unnecessary.

Abuse is more common and frequently happens in the form of false statements or misrepresentation in receiving or providing a service not delivered or a payment. Many times these abuses include multiple sources, which could be patients, physicians, hospitals, laboratories, health plans, as well as employees of state and federal government programs.

WHA is committed to deterring, detecting and investigating healthcare fraud and abuse. We need help in our fight from our team of employees, members, providers, hospitals and vendors. The fight against healthcare fraud and abuse is everyone's responsibility. Through our compliance program we have established a toll-free hotline, which you can help by calling and reporting what you believe to be fraudulent or abusive actions.

The WHA Compliance Hotline is: 1-888-372-8325

You may leave you name and number, so if we require additional information we can call you, but you may also remain anonymous if you prefer, either way, it is important you give the minimum information so we may investigate your concerns:

• The reason you believe that a fraudulent or abusive situation has occurred.
• Information regarding the item, service or issue in question.
• The date on which the item, service or issue in question was furnished or the incident occurred.
• The amount billed, if relevant.
• Any other information you have that is important to understanding the situation and will help with the investigation.

back to top