Fraud, Waste and Abuse Hotline

Have you ever been concerned that a patient might be using a Tufts Health Plan ID card fraudulently? Have patients ever given you information about questionable billing practices by other providers? Have you been made aware or do you suspect that a patient may be seeking a prescription for a non-legitimate medical purpose or abusing their pharmacy benefit?

If you were to have concerns like these, Tufts Health Plan has a Hotline for providers to report concerns about possible health care fraud. The Hotline was established to help Tufts Health Plan’s members and providers who have questions, concerns and/or complaints related to possible wasteful, fraudulent or abusive activity.

You can call the Tufts Health Plan Fraud Hotline to report your concerns 24 hours a day, 7 days a week at 1-800-246-1781. The information you provide will be forwarded within one business day to the Tufts Health Plan Corporate Compliance department to address your concerns.

You may choose to identify yourself or to remain anonymous. Our policy is to preserve the anonymity of Hotline callers, subject to limits imposed by the law. In some cases we are legally required to report certain types of potential crimes and infractions to external agencies.

Health care fraud and abuse affect everyone by contributing to the increase of health care costs. You can play an active role in keeping health care costs down by reporting any potential fraudulent practices to the Tufts Health Plan Fraud Hotline.

FWA Training Required for Medicare Providers
The Centers for Medicare & Medicaid Services (CMS) requires all Medicare Advantage-Prescription Drug health plans to ensure that their participating providers complete Fraud, Waste and Abuse (FWA) training no later than December 31, 2009, and annually thereafter. Additional information can be found on the Tufts Health Plan Fraud, Waste and Abuse Training page.

To Complete the Training
The online FWA Medicare Training is available on the HCAS Web site at hcasma.org. When you complete the training, click the link "ATTESTATION - Attest that you have completed the training."

If you need assistance or have questions about this training, please contact Tufts Health Plan Medicare Preferred Provider Relations at 800-279-9022.

Note: The information in this article was correct as of the date of posting and may not reflect subsequent policy changes. See Fraud, Waste and Abuse Training for Medicare Providers.

May 1, 2009
Revised July 20, 2009
Revised July 6, 2010