Avoid Provider Scams

CDPHP is on the case

Corporate Compliance
To help prevent and combat fraud, we have set up a Corporate Compliance and Integrity Program that monitors internal compliance with all laws and regulations.

Examples include:

• Your claim submissions were inappropriately altered.
• A patient’s personal health information was compromised.
• An employer group is involved in the submission of false claims.

Special Investigations Unit
Our Special Investigations Unit (SIU) detects and investigates health care fraud by reviewing computer records and working with law enforcement agencies to expose criminal schemes.

Billing and Reimbursement

We are committed to billing and reimbursement practices that comply with all federal and state laws, regulations, guidelines, and policies. CDPHP employees, agents, and contractors are prohibited from knowingly presenting or causing to be presented false or fraudulent claims for payment, as well as any other actions prohibited under the Federal and New York State False Claims Acts.

Fraud Examples:

• Billing for services not rendered.
• Billing for a higher level of service than what was provided.
• Billing diagnosis codes that were not related to the visit to get coverage (e.g., billing a diabetes diagnosis for someone who does not have diabetes to get coverage for services that would only be available for someone with diabetes).
• Billing a non-covered service as a covered service.
• Prescribing additional and unnecessary treatments (overutilization).
• Billing for a different service site to increase revenue.

We Want to Hear From You

If you know or suspect that fraud is taking place, call the CDPHP Fraud Hotline at 1-800-280-6885, e-mail us at specialinvestigationsunit@cdphp.com, or write to:

CDPHP
Special Investigations Unit
500 Patroon Creek Boulevard
Albany, NY 12206-1057 

Your confidentiality will be protected.