Report Fraud, Waste or Abuse (Medicare)

For members of:

• Elderplan Plus Long-Term Care (HMO-POS D-SNP)
• Elderplan for Medicaid Beneficiaries (HMO-POS D-SNP)
• Elderplan Select (HMO-POS I-SNP/IE-SNP)
• Elderplan Advantage for Nursing Home Residents (HMO-POS I-SNP)

Elderplan is committed to an environment where open, honest communication is the expectation, not the exception.

Most doctors, pharmacies, and care workers are honest. A few are not. If you think someone is cheating Medicare or Medicaid, please tell us.

On this page

• What fraud, waste, and abuse mean
• Signs to watch for
• How to report to Elderplan
• Other places you can report
• What to have ready

What fraud, waste, and abuse mean

• Fraud is when someone lies or tricks on purpose to get money from a health program.
• Waste is using more services than needed, or using health care money carelessly. This raises costs for everyone.
• Abuse is when actions lead to extra costs, or to payment for care that is not needed or not up to health care standards.

Signs to watch for

• A bill or statement lists care, tests, or equipment you never got.
• You are billed more than once for the same service.
• Someone offers you money or gifts to get care or services from them.
• A provider orders tests or prescriptions you do not need.
• Someone else uses your Elderplan, Medicare, or Medicaid card.

Protect yourself: Keep your cards safe, like a credit card. Only give your Medicare number to your doctors and others you know should have it. Check your bills and statements for mistakes.

How to report to Elderplan

If you would like to report a potential compliance issue or potential fraud, waste, or abuse (FWA), you have three options:

1. Contact the Elderplan Compliance Officer.
   Candice Weatherly
   Phone: 718-759-4260
   Email: cweather@mjhs.org

2. Report online.
   Submit your question or concern electronically to the Elderplan Compliance and Ethics Hotline (opens a non-Elderplan website). To ensure confidentiality, a third-party vendor operates the hotline.

3. Call the anonymous hotline.
   Call the anonymous Elderplan Compliance and Ethics Hotline at 1-855-395-9169. You do not have to give your name. To ensure confidentiality, a third-party vendor operates the hotline. 

Other places you can report

If you have Medicare (all Elderplan plans on this page):

• Medicare: Call 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. Calls are free, 24 hours a day, 7 days a week.

• U.S. Department of Health and Human Services, Office of Inspector General: Call 1-800-HHS-TIPS (1-800-447-8477). TTY users call 1-800-377-4950. Or report online at tips.oig.hhs.gov (opens a non-Elderplan website).

• Investigations Medicare Drug Integrity Contractor (I-MEDIC): For people in a Medicare Advantage Plan or Medicare drug plan. Call 1-877-7SAFERX (1-877-772-3379).

If you also have Medicaid:

Members of Elderplan Plus Long-Term Care and Elderplan for Medicaid Beneficiaries have both Medicare and Medicaid. You can use any of the options on this page. 

New York State Medicaid Fraud Hotline (Office of the Medicaid Inspector General): Call 1-877-87-FRAUD (1-877-873-7283). Or report online at omig.ny.gov. You do not have to give your name.

What to have ready

It helps to have:

• The name of the doctor, pharmacy, supplier, or company
• What happened and the date it happened
• Any bills or statements about it
• Your name and member ID or Medicare number, unless you want to stay anonymous