Resources for Healthcare Fraud and Abuse

Our Standards

Medical Associates is committed to conducting our business ethically and in compliance with all applicable laws. All employees, insurance agents, and other contractors are expected to act professionally and in a legally compliant manner, with honesty and integrity in all interactions. Learn more about our expectations and Code of Conduct.

Healthcare Fraud and Abuse

Healthcare fraud is a crime, and it affects everyone. Fraud and abuse in the healthcare industry lead to higher costs and higher premiums -- and undermines consumer confidence.

At Medical Associates, we have implemented a Compliance Program designed to prevent, detect, investigate and correct any activities or conduct that does not conform to all legal requirements. Our goal is to protect our members and clients -- and our own business – from health care fraud and abuse.

Fraud and abuse come in many forms. Examples include:

• Falsifying Claims
• Falsifying Eligibility Determinations
• Misrepresentation of Member Eligibility
• Misrepresentation of Residency and/or Citizenship Status
• Falsifying Billing for Services
• Forgery or Alterations of Prescriptions
• Fraudulent Enrollment Practices
• Misrepresentation of Medical Condition
• Fraudulent Credentials
• Theft of Durable Medical Equipment
• Fraudulent Recoupment Practices
• Failure to Report Third Party Liability
• Embezzlement

How Do I Avoid Health Care Fraud?

Take these steps to help protect yourself and others:

• Protect your health insurance card like you would a credit card. If your card is lost or stolen, contact Member Services immediately at 866-821-1362 or by email to MAHPMemberServices@mahealthcare.com.
• Carefully review each Explanation of Benefit (EOB) to ensure you received the services listed and all information is accurate.
• Helpful information for Medicare beneficiaries can be found at:
  “Protecting Yourself & Medicare from Fraud”
  Say No to Medicare Fraud video
  “Help Fight Medicare Fraud”
  “Identity Theft and Your Social Security Number"
  What You Need To Know About Misleading Advertising

What if I Suspect Fraud or Abuse?

If you suspect fraud or abuse, contact us as soon as possible.  You should also report any other compliance violations, such as HIPAA privacy and security violations or suspected criminal activity, and no matter whether it is by Medical Associates or any insurance agent, doctor, hospital, laboratory, or DME supplier. 

To report concerns, including anonymously, leave a message on our Compliance Hotline, available anytime, at 563-584-4795. You may also email MAHPComplianceHotline@mahealthcare.com.  Provide as much information as possible so that we may thoroughly investigate.

You also can report fraud and abuse to the federal and state government agencies listed below.

Other Ways to Report Insurance Fraud

• Submit an online tip to the U.S. Dept. of Health & Human Services, Office of the Inspector General (OIG), at https://oig.hhs.gov/fraud/report-fraud/
• In Iowa, file an online complaint or report insurance fraud or Medicare fraud at https://iid.iowa.gov/consumers/filing-complaints/report-insurance-fraud.  Or contact:

Iowa Insurance Division
1963 Bell Avenue, Suite 100
Des Moines, IA 50315
(515) 654-6600

• In Illinois, file a complaint at https://illinoisattorneygeneral.gov/File-A-Complaint/ or https://idoi.illinois.gov/consumers/file-a-complaint.html. Or contact:

Illinois Department of Insurance at
320 W. Washington Street
Springfield, IL 62767
Main: 217-728-4515
TDD: 866-323-5321

• In Wisconsin, report insurance fraud at https://oci.wi.gov/Pages/Consumers/Insurance-Fraud.aspx. Or contact:

Office of the Commissioner of Insurance
101 East Wilson St.
Madison, WI 53703
608-266-3585
Email: ocifraud@wisconsin.gov