We work to prevent, detect, investigate and correct incidents of Fraud, Waste and Abuse in accordance with contractual, regulatory and statutory requirements. We educate our employees and contractors on false claims acts and the roles such laws play in preventing and detecting fraud, waste and abuse in government health care programs.
We take appropriate disciplinary action against employees, providers, subcontractors, consultants, and agents found to have violated our policies or the Code of Conduct and/or committed Fraud, Waste or Abuse.
For good faith, anonymous reporting of any compliance concerns, including fraud, waste or abuse or other compliance-related matters, please call our Compliance Hotline toll free at 877-363-3065. You do not need to give your name. You may also email us at firstname.lastname@example.org. Please note: emails are not considered anonymous because they contain the sender’s email address.
For compliance issues, call 800-511-5010.
For privacy issues, call 855-879-8286.
As part of the Colorado Access compliance program, we have an obligation to report known or suspected fraud, waste and abuse. We use the terms “fraud,” “waste” and “abuse” defined below as applied to our business.
Some examples include billing for services not ordered or provided, providing false information about membership or eligibility, providing false information about credentials or certifications, and billing for services that were performed by an individual or entity that has been excluded from participation in government health care programs.
If you suspect fraud, waste or abuse, please contact us.
Fraud: An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him/herself or some other person.
Waste: Incurring unnecessary costs as a result of deficient management, practices, systems or controls; the over-utilization of services (not caused by criminally negligent actions) and the misuse of resources.
Abuse: Practices that are inconsistent with sound fiscal, business or medical practices, and that result in an unnecessary cost to government programs, or in seeking reimbursement for goods or services that are not medically necessary or that fail to meet professionally recognized standards for healthcare. It also includes member practices that result in unnecessary cost to Medicaid programs.