Fraud, Waste, & Abuse
What is Fraud, Waste, and Abuse (FWA)?
Fraud is lying about information for you or another person. Examples of fraud are:
- Letting someone else use your Member ID Card.
- Sending in false claims.
- Lying to get services that you do not need.
Waste is using more than is needed. Examples of waste include:
- Using or billing for more supplies than needed.
- Using or billing for more technology than needed.
- Using or billing for more hours than needed.
Abuse is providing or accepting products or services that are not needed or are outside normal practices. Billing for these products or services is an example of abuse.
Fraud, Waste, and Abuse (FWA) can be committed by a member, doctor, or other plan provider.
Problems with FWA
FWA is one reason medical care costs so much. FWA can lead to:
- Higher Copays.
- Higher premiums.
- Higher taxes.
Viva Health has a FWA program. This program helps us:
- Prevent FWA.
- Detect FWA.
- Investigate FWA.
- Correct FWA.
See the documents below for examples, descriptions, and the risks of FWA.
How to prevent FWA
You can help prevent FWA by following three easy rules:
- Protect your information. Only give your Member ID Card to a medical professional that needs it to care for you. Call us as soon as possible if your Member ID Card is lost or stolen.
- Identify FWA. Review your plan statements and make sure you and your plan are only being billed for the services you received.
- Know how to report. You can ask a question or report suspected FWA by any of the methods listed below. Remember - A person who tells us about FWA does not have to give their name. Any information you give us is kept private.
Fraud, Waste and Abuse Investigations
If potential FWA is identified, Viva Health will conduct an investigation. If the investigation identifies FWA, we will work with Medicare and law enforcement to correct the issue.
Report Suspected Fraud & Abuse
Online Fraud Report Form
Please fill out the form below to report suspected Medicare fraud. Your name is not required. Viva Health will protect your anonymity to the fullest extent of the law.
Please provide your contact information
Who do you suspect is committing fraud?
What Fraudulent activity occured?*
Contract Number: (if the fraud involves services provided to you)