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:

  1. 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.
  2. Identify FWA. Review your plan statements and make sure you and your plan are only being billed for the services you received.
  3. 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.
    • Call Viva Medicare Member Services at 1-888-830-VIVA (8482). TTY users call 711. Our call center hours are Monday – Friday, 8 a.m. to 8 p.m. Extended call center hours: October 1 – February 14, 8 a.m. to 8 p.m. seven days a week.
    • Write us:

      Viva Health
      Attn: Compliance Officer
      417 20th Street North, Suite 1100
      Birmingham, Alabama 35203

    • Contact us electronically (form below).
    • Call Medicare at 1-877-7SAFERX (1-877-772-3379)

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.

*Required Fields

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)

Additional Comments


Contact Us

Toll-free: 1-888-830-VIVA (8482)
TTY users, call: 711
Monday - Friday, 8am-8pm CST
Extended Office Hours:
(October 1 - February 14)
8am - 8pm CST Seven Days a Week

We're here for you

If you have questions or complaints about your Viva Medicare plan or care that you have received, we want you to let us know right away.

You may also contact Medicare to file your complaint by clicking here and follow the instructions on the form. To find out information about the Medicare Ombudsman click here.

By clicking the links above you may be directed away from vivamedicaremember.com
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Last updated 10/1/2015


Disclaimers

1Viva Medicare is an HMO plan with a Medicare contract and a contract with the Alabama Medicaid Agency. Enrollment in Viva Medicare depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium, and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Other providers are available in the Viva Medicare network. Please contact the plan for further details.

2Viva Medicare Extra Value is available to anyone who has both Medical Assistance from the State and Medicare. Other providers are available in our network.



Viva Medicare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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