Fraud, Waste and Abuse Prevention
Universal Health Care (UHC) is committed to detecting and preventing healthcare fraud and abuse.
Fraud and abuse within the healthcare system results in higher insurance costs to all persons and entities
including the Medicare/Medicaid program, individual health plan members, group plans and business partners,
as well as state and federal governments that are funded by taxpayers. UHC takes all allegations of fraud
and abuse or other compliance issues very seriously.
Review your monthly Explanation of Benefits (EOB) and ensure that you received all services stated on
the document. The EOB is a listing of medications that you received, the copayment that you paid, and
the amount that was billed to your insurance for the previous month. Look for incorrect dates of service or
services that you did not receive.
Review your Medicare Summary Notice (MSN) and ensure that you received all services stated on the document.
The MSN shows what Medicare was billed for, what Medicare paid and what you owe.
Be sure to protect your membership card, as it contains information regarding your benefits.
Beware of providers who use pressure tactics to convince you to accept a certain product or service.
Only allow appropriate medical professionals to review medical records or recommend services.
Stay informed about your Medicare/Medicaid and/or other insurance benefits.
Always keep proof of any payments you make to a healthcare provider.
Reporting Healthcare Fraud and Abuse
If you have a reason to believe that a healthcare provider is performing unnecessary or inappropriate services, or is
billing for services not given to you, you should report this immediately. Your report may be made confidentially.
To report any fraud and abuse, contact the Office of the Chief Compliance Officer at UHC by calling 1-866-690-4842 extension 6534.