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.
- 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 Service.
- Theft of member identity information.
Abuse is when a person or provider acts in a way that results in unnecessary healthcare costs. Abuse could include a provider rendering a medically unnecessary service, or billing in a way that make 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 8 p.m., or email [email protected]. You do not need to provide your name or member information, but 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
- Or send a letter to:
Medicaid Fraud Control Unit
Office of the Attorney General
One Ashburton Place
Boston, MA 02108
H7419_4520_CMS Approved
Page modified on: 4/7/2016 6:56:54 PM