What is Fraud, Waste, and Abuse (FWA)?

Fraud is lying about information for you or another person.

Examples of fraud are:

  • Letting someone else use your Member ID Card.
  • Sending in false claims.
  • Lying to get services that you do not need.

Waste is using more than is needed.

Examples of waste include:

  • Using or billing for more supplies than needed.
  • Using or billing for more technology than needed.
  • Using or billing for more hours than needed.

Abuse is providing or accepting products or services that are not needed or are outside normal practices.

Billing for these products or services is an example of abuse.

Fraud, Waste, and Abuse (FWA) can be committed by a member, doctor, or other plan provider.


PROBLEMS WITH FWA

FWA is one reason medical care costs so much.

FWA can lead to:

  • Higher Copays.
  • Higher premiums.
  • Higher taxes.

Viva Health has a FWA program.

This program helps us:

  • Prevent FWA.
  • Detect FWA.
  • Investigate FWA.
  • Correct FWA.

See the documents below for examples, descriptions, and the risks of FWA.


HOW TO PREVENT FWA

You can help prevent FWA by following three easy rules:

  1. Protect your information.

    Only give your Member ID Card to a medical professional that needs it to care for you. Call us as soon as possible if your Member ID Card is lost or stolen.

  2. Identify FWA.

    Review your plan statements and make sure you and your plan are only being billed for the services you received.

  3. Know how to report.

    You can ask a question or report suspected FWA by any of the methods listed below. Remember - A person who tells us about FWA does not have to give their name. Any information you give us is kept private.

    • Call Viva Medicare Member Services at 1-800-633-1542. TTY users call 711. Our call center hours are Monday – Friday, 8 a.m. to 8 p.m. Extended call center hours: October 1 – March 31, 8 a.m. to 8 p.m. seven days a week.
    • Write us:
      Viva Health
      Attn: Compliance Officer
      417 20th Street North, Suite 1100
      Birmingham, Alabama 35203
    • Contact us electronically (form below).
    • Call Medicare at 1-877-7SAFERX (1-877-772-3379)

Viva Health has a FWA program.

This program helps us:

  • Prevent FWA
  • Detect FWA
  • Investigate FWA
  • Correct FWA

FRAUD, WASTE & ABUSE INVESTIGATIONS

If potential FWA is identified, Viva Health will conduct an investigation. If the investigation identifies FWA, we will work with Medicare and law enforcement to correct the issue.


REPORT SUSPECTED
FRAUD & ABUSE

Please fill out the form below to report suspected Medicare fraud. No contact information is required but if you give your information it could help in the investigation. Viva Health will protect your anonymity to the fullest extent of the law.

*Required Fields


Online Fraud
Report Form


Please provide your contact information

First Name
Last Name
Email
Phone Number

Who do you suspect is committing fraud?

Accused First Name
Accused Last Name
Company Name
Phone Number
Address
City
Zip

What Fraudulent activity occured?

Description of Activity
Contract Number
(if the fraud involves services provided to you)

Additional Comments

Comments

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