Reporting Fraud, Waste and Abuse & Non-Compliance

 

AmericasHealth Plan (AHP) strives to assure an ethical, compassionate, efficient and compliant approach to healthcare delivery and to management services. AHP is committed to conducting its business with the highest ethical standards and in compliance with all applicable federal and state laws and regulations. In addition, AmericasHealth Plan is committed to detecting, correcting and preventing fraud, waste and abuse.

If you suspect fraud, waste, or abuse, or other issues of noncompliance, you must report it to AmericasHealth Plan and we will investigate. Your actions may help to improve the healthcare system and reduce costs for our members, customers, and business partners.

Did You Know?

You can easily and confidentially report a known or suspected violation to AmericasHealth Plan by:

Calling the AHP Compliance Hotline: (800) 584-0724

Emailing the AHP Compliance mailbox: compliance@americashp.com

You may also report an issue directly to AHP’s Compliance Officer:
Anita Guevin, Compliance Officer
200 S. Wells Road
Suite 200
Ventura, CA 93004
Phone: (800) 633-3313 x8612
Email: anita.guevin@amerciashp.com

You may remain anonymous if you prefer. All information received or discovered by the Compliance Office will be treated as confidential to the extent possible. The results of investigations will be discussed only with persons having a legitimate reason to receive the information.

AmericasHealth Plan enforces a strict policy of non-retaliation:

  • Retaliation against anyone who reports a compliance issue in good faith is strictly prohibited
  • If you see retaliation or believe that retaliation has occurred, you must report it.

Fraud Waste & Abuse Defined

Fraud is Intentional act of deception, misrepresentation, or concealment in order to gain something of value

Waste is Over-utilization of services (not caused by criminally negligent actions) and the misuse of resources.

Abuse Excessive or improper use of services or actions that are inconsistent with acceptable business or medical practice. Refers to incidents that, although not fraudulent, may directly or indirectly cause financial loss. Examples include:

  • Charging in excess for services or supplies.
  • Providing medically unnecessary services.
  • Billing for services that were never rendered.
  • Billing for services at a higher rate than is actually justified
  • Misrepresenting services resulting in unnecessary cost to the Medicare program, improper payments to providers, or overpayments