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
We conduct business with the highest ethical standards. Our compliance program helps our employees, business partners, and vendors meet our standards.
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.
This unit investigates reports of suspected fraud, waste, and abuse on behalf of us and our customers. Its mission is to prevent, identify, report and — when appropriate — recover money lost due to health care fraud, waste, and abuse. That helps ensure the money you pay in premiums gets used for legitimate health care purposes.
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
Our network providers, business partners, vendors, contractors, and employees are required to report suspected cases of fraud, waste, and abuse. There are several ways to file a report. You can choose the one that works best for you: