Fraud, Waste & Abuse
Health Share of Oregon is dedicated to investigating all allegations of suspected Medicaid fraud and abuse.
Health Share reports all verified cases of fraud to the Medicaid Fraud Control Unit (MFCU).
Here’s how you can report:
- Contact the anonymous Health Share Compliance Hotline at 503-416-1459
- Call the State of Oregon Department of Human Services (DHS) Fraud Hotline: 888-372-8301
- Complete and return the Fraud, Waste and Abuse reporting form.
You can fax the form to us at 503-459-5749 or you can mail the form to us at:
Health Share of Oregon
2121 SW Broadway, Suite 200
Portland, OR 97201
Individuals are protected by Federal law for good-faith reporting of all activities related to fraud or abuse. Companies are prohibited from discharging, demoting, suspending, threatening, harassing or discriminating against any employee who reports such acts.
What is Fraud?
Fraud is an intentional deception or misrepresentation, whether by act or omission, made by a person with the knowledge that the deception could result in some unauthorized benefit to himself/herself or some other person.
What is Abuse?
Abuse includes provider practices that are inconsistent with sound fiscal, business or medical practices, and result in an unnecessary cost to Medicare, Medicaid, Health Share or an enrollee, or in reimbursement for services that are not necessary or that fail to meet professionally recognized standards for health care. Abuse also includes enrollee practices that result in unnecessary costs.
What is Waste?
Waste is health care spending that can be eliminated without reducing quality of care. It includes inefficient use or management of resources, unnecessary expenses, or procedures that cannot reasonably be expected to yield better outcomes.
Who is impacted?
- We are all impacted by Fraud, Waste and Abuse in our health care system.
- Every dollar that is spent on fraudulent, abusive or wasteful activities is money that cannot be spent where it is needed most.
- In 2012, more than $9 million was ordered to be repaid in Fraud, Waste and Abuse cases in Oregon. Nationally the total was nearly $3 trillion.
What does Fraud look like?
Examples of fraud include…
- Billing for services not provided (phantom billing)
- Accepting money for referrals (kickbacks)
- Billing for unnecessary services or tests
- Billing twice for the same services
- Dispensing generic drugs and billing for brand-name drugs
- Billing for lengthy services that only take a short period.
Health Share of Oregon takes the issue of Fraud, Waste and Abuse very seriously. Our employees and our Board of Directors are required to go through annual training on how to recognize and report fraud. Below is an example of the type of training provided.