Health care fraud, waste, or abuse occurs when an individual or entity intentionally misrepresents facts to receive health plan coverage or reimbursement for health care services or supplies. Under state and federal laws, these occurrences are subject to loss of health care coverage, reimbursement, and/or civil or criminal penalties punishable by fines or imprisonment.
Definitions are as follows.
- Fraud – Conduct that involves intentional deception or misrepresentation, knowingly making a false claim, or other intentional or willful deception or misrepresentation known to be false or otherwise unlawful or improper, in order to receive some unauthorized benefit.
- Waste – An extravagant, careless or unnecessary utilization of or payment for health care services or supplies.
- Abuse – An activity or practice undertaken by an individual or entity that is inconsistent with sound fiscal, business or medical/dental practices and results in unnecessary cost to HMAA’s clients, reimbursement for health care services or supplies not medically necessary, or which fails to meet professionally recognized standards for health care.
If you suspect health care fraud, waste, or abuse by an HMAA group, member, provider, or other individual or entity, report it to HMAA at firstname.lastname@example.org or contact our Customer Service Center.