Everyone can make a difference to the bottom line.
Every year, more than $100 billion is billed to insurance companies through scams and fraudulent medical charges. To make up for these losses, you pay more in the form of higher premiums and taxes.
You can help by following these simple guidelines:
To combat and prevent fraud before it happens, we have set up a Corporate Compliance and Integrity Program to monitor and verify internal procedures with all laws and regulations. Our Special Investigations Unit (SIU) detects and investigates health care fraud by reviewing computer records and working with law enforcement agencies to uncover criminal activity.
Your Information is Safe with Us
In addition to our external program, we’ve take additional steps to safeguard your personal information. Our internal compliance program ensures that all CDPHP employees uphold their legal and ethical duties to members, practitioners, employers, brokers and the company as a whole.
What Does Corporate Compliance Misconduct Include?
We Want To Hear From You
If you know of suspect that fraud is taking place, please call the CDPHP corporate compliance officer at (518) 641-5260, or call the CDPHP Fraud hotline at 1-800-280-6885.
Download a copy of the CDPHP Corporate Compliance Policy.
Everyone can take steps to prevent committing and falling victim to fraud by following these simple guidelines.
The Federal False Claims Act (FCA) establishes liability for those making knowingly false or fraudulent claims against federally funded programs including Medicare and Medicaid, as well as those who knowingly make or use a false record or statement material to a fraudulent claim.
Violators of the FCA are subject to civil penalties for each false claim and related damages. Providers or suppliers who have been convicted of a violation may be excluded from participation in federal health programs.
Under the Federal False Claims Act, anyone who has direct information about an alleged false claim submitted to the government may file a lawsuit on behalf of the government in federal district court. The FCA provides protections to those who report a false claim.
New York State (NYS) False Claims Act
New York also imposes penalties and fines on those who submit false or fraudulent claims for payment to state or local governments under programs such as Medicaid. The penalty for filing a false claim in $6,000 to $12,000 per claim, in addition to related damages.
The NYS False Claims Act also provides protection to whistleblowers facing retaliation at work as a result of an action filed under the NYS False Claims Act. To learn more, a summary of Federal and New York statutes related to false claims is provided for your reference.
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