Fraud and Abuse

Help reduce health care fraud and abuse.

Fraud is when a person knowingly makes or permits another person to make a false statement in order to get services or items or receive a payment he or she does not have a right to receive.

Here are a few examples of fraud and abuse:

  • A member submits false or misleading information on a membership application form
  • A member makes a false request for reimbursement
  • A member fails to notify Tufts Health Direct of changes (such as residency) that affect a member's eligibility
  • A member lends his or her Tufts Health Direct member ID card to another person so he or she can get health care or pharmacy services

To report potential health care fraud and abuse, or if you have questions, please call us at 888-257-1985, Monday through Friday, 8 a.m. to 5 p.m., or email We don’t need your name or member information. You can also call our confidential hotline anytime at 877-824-7123 or send an anonymous letter to us at:

Tufts Health Plan
Attn: Fraud and Abuse
1 Wellness Way
Canton, MA 02021-1166