Health Care Fraud

It is the intent and purpose of Saint Vincents Catholic Medical Centers (SVCMC) and US Family Health Plan (USFHP) to adhere to all federal and state laws, including the Tricare Operations Manual and URAC accreditations standards, to detect and prevent fraud, waste and abuse regarding billing and payments. In addition, SVCMC/USFHP shall always protect those individuals who report actual or suspected wrongdoing (e.g. retaliation, defamation).

Fraud is any deliberate dishonest act with the intention of obtaining an unauthorized benefit for the person doing the act, or for the benefit of someone else who is not entitled to such benefit. Fraud results in insurance payments, including government payments, being used incorrectly and resulting in erroneous or inappropriate payments for services. Some examples of health care fraud are:

  • Using someone else’s USFHP insurance card to get health care services
  • Giving your USFHP insurance card to another person so they can receive health care services
  • Selling or diverting prescription medicines or items provided to you under the US Family Health Plan
  • Obtaining multiple prescriptions for the same drug from several doctors during the same time period
  • Forging or changing prescriptions
  • Receiving bills for equipment or services you never received.

The Compliance Department at SVCMC/USFHP investigates any and all charges, as well as actual or suspected health care fraud.

What can you do to help?

  • Never loan your USFHP insurance card to anyone
  • Report a lost USFHP insurance card immediately
  • Report receiving a bill for services you didn’t receive

All reports will be investigated and kept confidential. SVCMC/USFHP takes its responsibility to protect your right to report very seriously. SVCMC/USFHP prohibits any individuals in the workforce from threatening, coercing, harassing, retaliating or discriminating against anyone making a report. In addition, workforce members are prohibited from refusing to take a report or refusing to forward a report to the appropriate individual.

Report any suspicions of fraud or concerns to:

SVCMC/ USFHP Compliance Officer at the Compliance HelpLine (212)-356-4402 or the Compliance Officer (646)-740-8233