Fidelis Care Special Investigations Unit
What is Healthcare Fraud?
Healthcare fraud is an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person, including any act that constitutes fraud under applicable federal or state law.
Provider Fraud and Abuse
Some examples of Provider Fraud and Abuse:
Some examples of Member Fraud:
What Fidelis Care is doing to Stop Fraud
Fidelis has established its Special Investigation Unit to investigate allegations of Fraud by Providers, Members, Contractors, Employees or others. The Fidelis Care Special Investigation Unit is staffed by trained professionals who will vigorously look into each case. The Fidelis Special Investigation Unit has recently implemented a state of the art Fraud and Abuse detection system to further enhance its fraud fighting capabilities. Fidelis Care is committed to identifying and stopping healthcare fraud.
Why you should report Healthcare Fraud
According to The National Healthcare Fraud Association, "...estimates that of the nation's annual health care outlay, at least 3 percent - or $51 billion in calendar-year 2003 - is lost to outright fraud. Other estimates by government and law enforcement agencies place the loss as high as 10 percent of our annual expenditure - or $170 billion - each year." Like many other crimes Healthcare Fraud acts like a hidden tax increasing the costs for healthcare to everyone.
How to Contact the Special Investigation Unit at Fidelis Care
Learn more about Healthcare Fraud
Visit these sites to learn more about healthcare fraud and how it affects you.
National Healthcare Anti-Fraud Association
Health and Human Services Office of the Inspector General
New York State Attorney General
New York State Department of Health
New York State Office of the Medicaid Inspector General
Reporting Compliance Complaints and Fraud
Compliance Programs for Providers Accepting Medicaid