Fight Fraud
Help CDPHP Fight Fraud!
Every year as much as $100 billion is stolen from insurance companies in the form of scams and illegal medical charges. That's money that needs to be recouped in premiums and tax dollars out of the pockets of honest individuals.
What can be done about it? Plenty! CDPHP has a Corporate Compliance and Integrity Program to help monitor internal compliance with all laws and regulations. We also have a Special Investigations Unit (SIU) to detect and investigate health care fraud.
Our SIU investigators review computer records and work with law enforcement agencies to expose criminal schemes. But they need your help.
Here are things you can do:
- Understand your coverage and the care provided to you. Review all statements and paperwork from CDPHP and physicians who are treating you.
- Make sure that you actually received the treatments that providers claim were provided. Question any suspicious charges.
- Beware of “free” offers. These may actually be deceitful efforts to bill CDPHP for treatment you don't need or never received.
- Protect your ID card like you would a credit card. In the wrong hands, a health insurance card is a license to steal!
- Most important of all, report suspected fraud.
Billing and Reimbursement
CDPHP is committed to ensuring that its billing and reimbursement practices 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.
Federal False Claims Act
The Federal False Claims Act establishes liability for any person or entity that knowingly presents or causes to be presented a false or fraudulent claim involving any federally funded program including the Medicare and Medicaid Programs. A claim includes any request or demand for money that is submitted to the government or its contractors.
Violators of the Federal False Claims Act can be subject to civil penalties for each false claim submitted in addition to related damages. Further, the Office of Inspector General (OIG) may seek to exclude a provider or supplier convicted of a violation from participation in federal health care programs.
Under the Federal False Claims Act, any person with direct and non-public knowledge that an alleged false claim has been submitted to the government for payment may file a lawsuit on behalf of the U.S. government in a federal district court. The False Claims Act also provides protections to a person who reports a false claim to the government and/or experiences retaliation for their action.
New York State (NYS) False Claims Act
The NYS False Claims Act also imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from any state or local government, including health care programs such as Medicaid. The penalty for filing a false claim is $6,000-$12,000 per claim in addition to related damages.
The NYS False Claims Act also provides protections to a person who experiences retaliation by their employer as a result of their furtherance of an action under the NYS False Claims Act. To learn more, a summary of Federal and New York Statutes relating to filing false claims is provided for reference.
To request a copy of CDPHP’s False Claims Act Corporate Policy, please contact CDPHP’s Compliance Officer at (518) 641-5260.
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, New York 12206-1057
Thank you for helping us safeguard your health care dollars! Your confidentiality will be protected.