• Fraud, Waste & Abuse, Misuse of Information and Impermissible Disclosures

Fraud, Waste and Abuse (FWA), Misuse of Information and Impermissible Disclosures

For Members  |  For Providers  |  For Employees

How to Report Suspected Fraud, Misuse of Information and Impermissible Disclosures

BY PHONE

Call Senior Whole Health's Fraud Hotline
1-800-341-4915

Call Senior Whole Health's Anonymous Compliance Hotline

1-800-915-2108

You don't have to give us your name and making a report will never affect your right to healthcare coverage.

Report Suspected Fraud:

Office of the Inspector General
1-800-HHS-TIPS (1-800-447-8477)

Centers for Medicare and Medicaid Services 
1-800-MEDICARE (1-800-633-4227)

Report Suspected Misuse of Information and Impermissible Dislosures:

Office for Civil Rights
1-800-368-1019
TDD 1-800-537-7697

If you see something, say something.


For Members

What is FWA? And, how to recognize it.

Fraud, waste and abuse (FWA) is what happens when Medicare — or a managed care plan such as Senior Whole Health — is billed for coverage of services you never got or didn't need.

Healthcare fraud, waste and abuse are crimes under both state and federal laws. The penalties for submitting a false claim under the Medicare or Medicaid programs include hefty fines and possible jail time.

Senior Whole Health asks you to be on the lookout for possible fraud, waste and abuse.

For example, if:
  1. Someone offers to pay you money for the use of your insurance card.
  2. You are encouraged to join another plan with an offer of cash or a gift card worth more than $15.
  3. You continue to receive additional medical supplies you no longer need.
Importance of reporting

Healthcare fraud, waste, and abuse costs America billions of dollars every year. It also drives up the cost of healthcare for everyone.

Senior Whole Health takes fraud, waste, and abuse very seriously. We have set up a toll-free, anonymous hotline where anyone can report suspected fraud at any time. It is completely confidential and Senior Whole Health does not retaliate against reports of suspected FWA or non-compliance.

We appreciate your cooperation with the law!

What is Misuse of Information and Impermissible Disclosures? And, your rights.

Senior Whole Health is required by law to protect your health information. We are not authorized to release your information to anyone without your permission or otherwise allowed or required by law. If Senior Whole Health releases your information contrary to your wishes, or in violation of the law, that may be considered a misuse of your information and/ or an impermissible disclosure of your information.

Should you have any concern that your information is being used in an impermissible manner, you have the right to file a complaint. You may file a complaint by contacting Senior Whole Health’s Anonymous Compliance Hotline at the telephone number listed above, or via Senior Whole Health’s online option. You may also contact the Office for Civil Rights at the telephone number listed above for information on how to file a written complaint with the Office for Civil Rights by mail, fax, or via the online portal: OCR Complaint Portal.

For Providers

Training

As a contracted provider with Senior Whole Health, federal law requires that you and all of your organization's employees take Fraud, Waste, and Abuse (FWA) training on an annual basis (see 42 CFR § 422.503(b)(4)(vi)(C)). Many of our providers already meet this requirement through their enrollment in the Medicare program.

If you are not a Medicare-participating provider or still need to take FWA training for this calendar year, please visit the standardized web-based training module developed by CMS.*

You should download the training titled Medicare Parts C and D Fraud, Waste, and Abuse Training and Medicare Parts C and D General Compliance Training.

Please ensure that your employees also follow this requirement, including contractors and temps. Once you have completed the FWA training you should print the completed certificate. Your organization should keep a record of attendance for both yourself and all of its employees. These records must be kept for at least 10 years.

Click here to view Senior Whole Health's Fraud, Waste and Abuse Policy.

Reporting

If you suspect fraud, waste, abuse, or any other kind of non-compliance, you should promptly report it to Senior Whole Health by calling the SWH Fraud Hotline at 1-800-341-4915, our anonymous compliance hotline at 1-800-915-2108 or the Main SIU Hotline at 1-800-755-0850.

Senior Whole Health does not retaliate against reports of suspected FWA or non-compliance. We appreciate your cooperation with the law.


For Employees

Reporting

The Senior Whole Health reputation for integrity and continued success depends on each of us being honest and following all laws and regulations. Fraud, dishonesty, or criminal conduct on the part of any employee, officer, director, or anyone doing business with the company will not be tolerated.

Senior Whole Health employees are expected to report any incidents of fraud, waste, or non-compliance. Supervisors are required to set an ethical example for their employees. Employees are encouraged to first address any compliance, HIPAA, fraud, waste or abuse questions or concerns to your supervisor first. However, if you  don't feel comfortable discussing it with your supervisor or manager, you may call the anonymous compliance hotline 24 hours a day, 365 days a year.

All reports are handled confidentially and the reporter is protected from any form of retaliation. Anyone attempting to retaliate against an employee who makes a report or calls the Hotline in good faith will be subject to disciplinary action, up to and including termination of employment.

Training

All employees, temporary, and contracted workers must take the annual Fraud, Waste, and Abuse training as a condition of continued employment.

* By clicking this link, you will be leaving seniorwholehealth.com.

View the Senior Whole Health Fraud, Waste and Abuse Policy.

Last Updated 12/06/2018