Fraud is when a person knowingly makes or permits another person to make a false statement to obtain a payment, a service, a benefit or something else of value. Examples of fraud may include:
- Providers billing for a service they did not provide, putting false information on a prior authorization form, or ordering or providing a service they know is not necessary.
- Providing something of value (cash, gift cards, free services) to members, brokers or other providers for referring or arranging services that result in claims submitted to the health plan.
- Members submitting false or misleading information on a membership application form, making a false request for reimbursement, failing to notify Tufts Health Plan of changes (such as residency) that affect the member's eligibility, or lending their Tufts Health One Care member ID card to another person so they can get health care or pharmacy services.
- Theft of member identity information.
Abuse is when a person or provider acts in a way that results in unnecessary health care costs. Abuse could include a provider rendering a medically unnecessary service or billing in a way that makes a service more costly than necessary.
To report potential health care fraud and abuse or if you have questions, please call us at 1-855-393-3154 (TTY: 711), Monday through Friday, from 8 a.m. to 5 p.m., or email [email protected]. You do not need to provide your name or member information. Please be aware that the email and telephone options above may reveal your contact information, such as the number from which you are calling or your email address.
If you wish to report anonymously, you can call our toll-free confidential hotline anytime at 1-877-824-7123 or send an anonymous letter to us at:
Tufts Health Plan
Attn: Special Investigations Unit
P.O. Box 524
Canton, MA 02021-1166
If you wish to contact the Commonwealth of Massachusetts, you may:
- Call the Medicaid Fraud Tip line at 1-617-963-2360
- File a complaint online at mass.gov/how-to/file-a-medicaid-fraud-complaint (link opens outside Tufts Health Plan's website)
- Or send a letter to:
Medicaid Fraud Control Unit
Office of the Attorney General
One Ashburton Place
Boston, MA 02108
Disclaimers
Tufts Health One Care is a Dual Special Needs Plan (D-SNP) health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. Enrollment in the plan depends on the plan’s contract renewal with Medicare.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook (2026).
If you speak Spanish, language assistance services, free of charge, are available to you. Call 1-855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m. (Please note: Our hours shift to Monday through Friday, from April 1 through September 30). The call is free.
Si habla español, tiene disponible los servicios de asistencia de idioma gratis. Llame al 1-855-393-3154 (TTY: 711), siete días de la semana, de 8 a.m. a 8 p.m. (Ten en cuenta lo siguiente: Del 1 de abril al 30 de septiembre, nuestro horario pasa a ser de lunes a viernes). La llamada es gratuita.
You can get this document for free in other formats, such as large print, formats that work with screen reader technology, braille, or audio. Call 1-855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m. (Please note: Our hours shift to Monday through Friday, from April 1 through September 30). The call is free.
The List of Covered Drugs and/or pharmacy and provider networks may change from time to time throughout the year. We will send you a notice before we make a change that affects you.
Benefits may change on January 1 of each year.
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