Report Fraud, Waste, and Abuse

How Health Care Fraud Can Affect You

Protecting you from fraud, waste, and abuse is part of our mission to provide quality health care. Kaiser Permanente takes its responsibilities towards preventing fraud, waste and waste abuse very seriously.

What is Health Care Fraud

Fraud is the intentional deception or misrepresentation by a person who is aware that this action could result in an unauthorized benefit for themselves or others.

Waste is overusing, or the inappropriate use, of organizational or government resources.

Abuse is the practice of causing unnecessary costs to the Medicaid program.

• Member Examples
  • Falsely reporting your income and/or assets to qualify for Medicaid
  • Lending your member ID card or using another ember’s ID card to obtain health services
  • Selling or making changes to a prescription medicine
• Provider Examples
  • Providing services that are not medically necessary
  • Billing for services that were not provided
  • Billing multiple times for the same service

What Actions Kaiser Permanente Takes to Address Fraud

Kaiser Permanente has a team of experienced crime and fraud investigators who review and investigate reported cases of potential fraud, waste, or abuse. They also investigate misconduct identified through monitoring our systems and operations.

Our investigators will work with state and federal law enforcement, regulatory agencies and other insurance companies to detect and prevent health care fraud and assist in the pursuit of restitution and/or prosecution of health care fraud offenders. The results are also reported to the Maryland Department of Health. People who commit fraud, waste or abuse activities may lose their health benefits, be fined or jailed.

How to Report Fraud, Waste, or Abuse

If you suspect or know that fraud, waste, or abuse is occurring, report it immediately Reporting fraud, waste, and abuse will not affect how you will be treated by Kaiser Permanente. There are many ways to report fraud, waste, and abuse.

• Call Member Services at 1-855-249-5019 or write to Kaiser Permanente at:
  • Compliance Department Program Integrity Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. 2101 E. Jefferson St. Rockville, MD 20852
• Contact the Maryland Department of Health, Office of the Inspector General:
  • 1-866-770-7175
  • http://dhmh.maryland.gov/oig/Pages/Report_Fraud.aspx
• Contact the U.S. Department of Health and Human Services, Office of the Inspector General:
  • 1-800-447-8477
  • https://oig.hhs.gov/fraud/report-fraud