AboutUs

PREVENTING FRAUD

Preventing healthcare fraud, waste and abuse

Fraud is generally defined as intentional misuse of information in an effort to receive payment. Waste involves using, consuming, or spending thoughtlessly or carelessly. Abuse involves improperly using program resources for personal gain. Here are some examples of fraud, waste, and abuse:

  • A provider billing for medical services or items that were not ordered or provided
  • A provider providing services or items that a person does not need or are not medically necessary
  • A provider billing for services that are more complex than what was actually performed, resulting in higher costs
  • A patient who may or may not be ill seeing doctor after doctor in order to obtain multiple prescriptions for painkillers
  • A member receiving suspicious phone calls asking for personal health information

Reporting Fraud, Waste, and Abuse

If you suspect fraud, waste, or abuse in the healthcare system, you can report it to Gundersen Health Plan, and we will investigate. To protect yourself from fraud, review any bills that you receive from healthcare providers. If you see something that does not look right, you should report it.

How to Report Fraud, Waste, and Abuse

To report any suspected fraud, waste, and abuse, you can contact Customer Service:

You can also report to the Compliance Hotline:

  • Local telephone number: (608) 644-3495
  • Toll free telephone number: (844) 492-2996

Callers may remain anonymous, if preferred. All information will be kept strictly confidential to the fullest extent possible. No retaliatory action will be taken or will be allowed against any person who reports potential issues. Once an issue is reported, Gundersen Health Plan will begin an investigation and will report to the appropriate authorities, if necessary.

This web page was last updated August 9, 2017.