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Working together to prevent fraud and abuse

Fraud and Abuse cost the healthcare industry billions of dollars each year. It costs all of us through tax increases and higher health insurance premiums. It also takes money away from other important programs.

Understanding fraud and abuse

Fraud is when a person gets healthcare services by being dishonest on purpose. There are several ways this can be done, including:

  • Using someone else’s insurance card
  • Providing incorrect information to healthcare providers, insurers or government agencies
  • Giving a healthcare provider their health insurance identification number so the provider can bill for services that weren't delivered

Abuse is when you ask for or a provider gives you services that are not normal for your condition or that are not medically necessary.

How can you help?

You can help prevent fraud and abuse by:

  • Protecting your personal information
  • Never giving your insurance card or identification number to anyone other than a healthcare provider you are seeing for covered services
  • Never giving your card or your insurance identification number to anyone promising you free items or services or calling or visiting you to sell you anything

If you are a Medicaid recipient, be sure you are keeping your Medicaid information current.

  • Notify WellSense if your Medicaid eligibility changes
  • Notify WellSense if your contact information changes
  • Let providers know if you have other insurance or if you are seeking care due to an accident
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To help in identifying errors or fraud or abuse please fill out and return to WellSense any questionnaires you receive from us asking about certain services you might have received.

To help in identifying errors or fraud or abuse please fill out and return to WellSense any questionnaires you receive from us asking about certain services you might have received.

What should you do if you suspect healthcare fraud or abuse?

You can help by immediately reporting any suspicious behavior related to healthcare services to WellSense.

  • Call our anonymous hotline at 1-888-411-4959
  • Fax the information to us at 1-866-750-0947
  • Send an email to FraudandAbuse@WellSense.org
  • Write to us at the address below

WellSense Medicare Advantage Plan ATTN: Special Investigations Unit 529 Main Street, Suite 500 Charlestown, MA 02129

You will not need to give your name. If you do give your name, we won’t share it with any of your healthcare providers.