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Health Partners is the Philadelphia area’s 
		  only health plan owned by a partnership of local hospitals.
 
Health Partners: Service. Benefits. Respect.
 
NCQA Accreditation: Health Partners Medical Assistance Plan.
 
 
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Monday, January 05, 2009
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"New" Member Training Presentation
Fraud and Abuse Information & Hotline
Health Partners’ Special Investigations Unit (SIU)

Health Partners prohibits all illegal and/or unethical conduct by members, employees and providers. Our Special Investigations Unit (SIU) has been developed to proactively address questionable activity and to investigate referrals of illegal and unethical conduct. Investigative findings are forwarded to Health Partners’ Legal Affairs department for appropriate action.

The following list gives some examples of illegal and/or unethical conduct:


  Members selling membership cards or ID numbers

  Members selling medications obtained through the program

  Members obtaining services or equipment not medically necessary for their conditions

  Employees selling Health Partners information

  Employees accepting money or gifts in exchange for manipulating some part of Health Partners’ system

  Providers up-coding claims or submitting claims for services not provided

  Providers providing false statement to obtain credentials (MediCheck)

  Pharmacist paying provider kickbacks for referrals

  Provider paying members incentive for patronage

Please call the SIU Hotline at 1-866-HP-SIU-4U if you suspect illegal and/or unethical activity among our members, employees or providers. Each call is evaluated by an investigator. All calls are confidential and may be made anonymously.