REPORT FRAUD AND ABUSE
To report potential fraud or abuse, you may contact Optum's Compliance Officer, Josh Albert, using the contact information below. You may remain anonymous by stating this in your email or message left to us.
Optum Pierce BHO Compliance Officer
3315 South 23rd Street, Suite 310
Tacoma, WA 98405
PHONE: (253) 292-4195
FAX: (253) 292-4219 to the Attention of Compliance Officer
Fraud and Abuse as defined by The Centers for Medicare and Medicaid Services (CMS):
Fraud is an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to them or some other person and includes any act that constitutes fraud under applicable federal or State law.
Abuse refers to a provider’s or entity’s actions that are inconsistent with sound fiscal, business, or medical practices and results in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary, or that fail to meet professionally recognized standards for health care.
Examples of Fraud and Abuse may include:
- Duplicate/Double billing
- Unbundling services to bill separately when they are a single service
- Billing for services not medically necessary
- Billing for services not rendered
- Over/Under utilization of services
- Upcoding services from a lower classification to seek additional reimbursement
- Alteration of chart note / medical record documentation
- Misrepresentation of services
Reports are kept confidential and complainants are protected from retaliation. All reported compliance concerns will be reviewed timely and as needed, follow up will be provided to the complainant.