We're a nonprofit health plan. That means we don't work to make money for investors or shareholders. Instead, our commitment is to you. To protect you and your health care dollars, our team works to find and report potential cases of fraud, waste, or abuse. You can help report issues too.
Fraud is when someone lies to an insurance company to get money. Waste happens when health care services are used more than necessary. And abuse occurs when best practices aren't followed.
You may never need to worry about these kinds of losses. But we're always looking out for them because they can:
- Put your health at risk if you don't get proper care
- Make your health care more expensive
- Drive up the cost of your insurance premiums
Standards of conduct
These standards help our vendors and business partners understand how we do business and their responsibilities in serving our members.
Our contracts with the Minnesota Department of Human Services (DHS) and U.S. Centers for Medicare and Medicaid Services (CMS) require us to apply the standards to all our direct and indirect business partners and vendors.
Examples of fraud include:
- Billing for a medical service or equipment that wasn't provided
- Using another person's Medica ID card to obtain medical services