Help us prevent healthcare fraud

Health insurance as well and prescription drug fraud and abuse costs billions of dollars each year and affects all of us by raising the cost of healthcare and health insurance premiums. Detecting and reporting fraud, waste and abuse is an important part of PUP’s fraud and abuse program - and we need your help.

What can I do?

  1. Always review your bills, claim forms and “Explanation of Benefits” (EOB) statements. Ask yourself the following questions:
    • Did I receive the treatment, product or prescription drug listed?
    • Was the treatment or product, to the best of my knowledge, relevant to my condition?
      • Your doctor should be willing to answer any questions you may have.
    • Has this treatment or product been billed before?
      • Billing twice for the same service may be a simple clerical error, but may also be a deliberate attempt to defraud you and PUP.
  2. Protect your member ID card and ID number. If you lend your card to someone else to use, you are committing fraud. Report lost or stolen ID card to PUP as soon as possible. Someone could use your ID number to bill for services you didn’t receive.
  3. If you have a question or concern about a bill, a procedure or diagnosis, contact your provider, as there may have been a clerical error or misunderstanding. If this does not resolve the issue, you may report your concern to our Customer Service telephone number listed on your ID card. Or you may call our toll-free hotline at 1-866-461-5705 and make an anonymous report. You may use the form provided below to send us a report.
  4. The Centers for Medicare and Medicaid Services, the federal government agency that oversees the Medicare Advantage program, has contracted with a Medicare Integrity Contractor (MEDIC) to monitor complaints and conduct fraud investigations concerning prescription drugs. You may report potential fraud, waste or abuse pertaining to your prescription drug benefit to MEDIC by calling 1-877-772-3379. You may also visit their website using the link below. The website includes a fraud complaint referral form that you may find useful. Go to www.healthintegrity.org

Examples of typical complaints include:

  • Someone pretends to represent Medicare or Social Security and asks you for your Medicare or Social Security number, bank account or credit card information.
  • Someone asked you to sell your Medicare plan ID card.
  • Someone offered you cash or a gift worth more than $15 to sign up for a Medicare plan.
  • You were encouraged to disenroll from your plan.
  • Your pharmacy did not give you all your drugs, you were billed for drugs that you didn’t receive or you received a different drug than your doctor ordered.
  • Someone asked you to get drugs for them using your ID card.
  • Your Medicare plan did not pay for your covered drugs.

PUP will not tolerate fraud. Please feel free to call our 24-hour toll-free hotline at 1-866-461-5705. To submit a report concerning a suspicious or fraudulent incident, please use the form provided below.