Addressing Fraud, Waste, and Abuse

Reporting

It is in your best interest to prevent and detect FWA by reporting suspected individuals, entities, and activities. Central Health Plan of California is committed to detecting and preventing health care fraud, waste, and abuse. Central Health Plan takes all allegations of fraud, waste, abuse or other compliance issues very seriously.

If you suspect fraud, waste, or abuse, report to Central Health Plan through one of the following methods, c/o Annie Hsu Shieh, Senior Compliance Director:

Telephone

The Central Health Plan Compliance Hotline (626-388-2392) is a dedicated telephone line and voice mailbox that can be used twenty-four hours a day, from any location, for reporting concerns or violations.

Mail:

1540 Bridgegate Drive, Diamond Bar, CA 91765

E-mail:

compliance@centralhealthplan.com
Individuals wishing to report a suspicious incident may identify themselves, or remain anonymous.
Thank you for helping us fight fraud, waste, and abuse!

In our strides to improve the healthcare system, AmericasHealth Plan has made a commitment to detecting, correcting, and preventing fraud, waste, and abuse.

Success in this effort is essential to maintaining a healthcare system that is affordable for everyone. AHP is undertaking a nationwide campaign to get the word out about how contracted physicians, other health care providers, and business partners can help with fraud, waste, and abuse detection, correction, and prevention.


What are Fraud, Waste, and Abuse?

Fraud is generally defined as knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program.

Waste is overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the health care system, including the Medicare and Medicaid programs. It is not generally considered to be caused by criminally negligent actions, but by the misuse of resources.

Abuse includes any action(s) that may, directly or indirectly, result in one or more of the following:

  • Unnecessary costs to the health care system, including the Medicare and Medicaid programs
  • Improper payment for services
  • Payment for services that fail to meet professionally recognized standards of care
  • Services that are medically unnecessary

Abuse involves payment for items or services when there is no legal entitlement to that payment and the entity supporting Humana (e.g. health care provider or supplier) has not knowingly and/or intentionally misrepresented facts to obtain payment.

Our Policies

View our Fraud, Waste, and Abuse policies here.