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Fraud, abuse and waste are
widespread in the health care industry and generally result in the
increase of health care costs. VISTA* is dedicated to combating fraud,
abuse and waste through its Fraud Prevention Program. This program is
designed to assist in the detection and elimination of all health care
fraud, abuse and waste.
The most common types of health care fraud,
abuse and waste are:
- Billing for services never rendered
- Billing for more expensive services then were actually
provided
- Incorrectly stating a member's diagnosis to maximize
payment
- Performing medically unnecessary services solely for the
purpose of generating revenues
- Misrepresenting non-covered procedures as medically
necessary
- Selling or sharing a member's identification number for
the purpose of filing false claims
- Enrolling subscribers to an employer's group when the
subscriber is not employed by the group
If you believe you
have information relating to health care fraud, abuse and waste, please
contact our Internal Audit and Fraud Prevention Department. The Department
will review the information provided and will maintain the highest level
of confidentiality as permitted by law. Suspected acts of fraud, abuse and
waste may be submitted by using our "Fraud, Abuse and Waste Referral
Form". This form is available online or feel free to download a copy and
mail it to the listed address on the form. Please click on one of the
links below and follow the instructions listed on the form:
You may prefer to contact VISTA's Internal Audit and
Fraud Prevention Department
by calling 1-800-996-5751.
You can
help support VISTA's mission to reduce and eliminate fraud in the health
care industry by following a few simple guidelines:
- Use discretion when providing your health care
information, including your member identification number. Be cautious of
"free" medical treatments where you are required to provide them with
your health care information.
- Read your Explanation of Benefits (EOB) carefully. Verify
the services described on the EOB are the same services you received by
the billing provider.
- Understand your VISTA benefit plan and what types of
treatments, drugs, services, etc., are
covered.
*References to VISTA include Vista
Healthplan, Inc., Vista Healthplan of South Florida, Inc., Vista Insurance
Plan and other affiliated entities.
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