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Health Care Fraud – What You Should Know

Priority Partners wants to find and stop health care fraud among its members.  Fraud is any dishonest act that results in a benefit to the person doing the act or someone else that he or she is not entitled to.  Some examples of health care fraud are:

• Using someone else’s medical assistance card to get health care services.
• Loaning your medical assistance card to another person so that they can receive health care services.
• Using tricks or scams to get someone else’s medical assistance number. 
• Using someone else’s name, social security number, or other personal information to be eligible for the medical assistance program.
• Hiding income and assets to qualify for the medical assistance program.
• Living in another state while getting Maryland medical assistance benefits.
• Selling items provided to you under the medical assistance program.
• Selling prescription medicine.
• Getting many prescriptions for the same drug from several doctors during the same time period.
• Forging or changing prescription forms.

Priority Partners’ Compliance Department investigates charges of health care fraud.  These are then reported to the Maryland Department of Health and Mental Hygiene (DHMH).  DHMH may perform its own fraud investigation, and takes action against people who are found to have committed fraud. 

How Can I Help?

You can help reduce health care fraud by following these simple rules:

• Never loan your medical assistance card to anyone.
• Guard your medical assistance number as you would your social security number.
• Follow all medical assistance rules.
• Report all suspicions of fraud.

What Should I do if I Know or Suspect that Someone has Committed Fraud?

If you know or suspect that someone has committed health care fraud, you should report it immediately. There are several ways to report fraud:

• To report to Priority Partners
  • Click on the link to the Compliance Reporting Form
  • Call the Compliance Line at 410-424-4996
  • Send an email to Compliance@jhhc.com
     

• To report to DHMH

  • Call the Program Integrity Unit at 1-866-654-4421
  • Contact the Maryland Department of Health and Mental Hygiene
  • Send a letter to:
    DHMH Program Integrity Unit
    201 West Preston Street
    Baltimore, MD 21201
     

• Contact your local Department of Social Services
  
  Health care fraud affects everyone, especially those of you who receive care. If you believe someone is cheating Priority Partners or the Maryland Medical Assistance Program, please report the act to DHMH or the Department of Social Services. You can remain nameless, and all fraud reports are kept confidential.