English Protecting Yourself Against Fraud, Waste, and Abuse Fraud is generally defined as making a false claim in an effort to receive payment. For example, fraud in the healthcare industry can involve: Billing for medical services that weren’t ordered or provided Billing for durable medical equipment items that weren’t ordered or provided Providing services or items a person doesn’t need based on his or her medical history “Doctor shopping” – when a patient who may or may not have a legitimate physical ailment goes from doctor to doctor to obtain multiple prescriptions for narcotic painkillers You are one of the first lines of defense against Medicare fraud - take action to protect your Medicare benefits! Report services or items that you have been billed for but did not receive Refuse medical supplies you did not order Return unordered medical supplies that are shipped to your home Report companies that send you these items Review your medical statements Make sure you receive the services or items billed Check the number of services billed Ensure that the same service has not been billed more than once Protect your identity and benefits Never give out your Social Security, Medicare, health plan numbers, or banking information to someone you don’t know Carefully review your Plan Statement to ensure all the information is correct Know that free services DO NOT require you to give your plan or Medicare number to anyone Be on the lookout for fraudulent schemes such as: People using your Medicare or health plan member number for reimbursements of services you never received People calling you to ask for your Medicare or health plan numbers People trying to bribe you to use a doctor you don’t know to get services you may not need You can report potential compliance issues and/or issues with fraud, waste and abuse to Golden State Medicare Health Plan’s Compliance Officer. Brian P. Gillan, Esq. 1-855-600-0015 www.lighthouse-services.com/gsmhp (Available 24 hours a day, 7 days a week and reports may be made anonymously) compliance@gsmhp.com For anonymous reporting please mail concerns to: Golden State Medicare Health Plan C/O Brian P. Gillan, Esq. P.O. Box 10729 Newport Beach, CA 92658 Golden State Medicare Health Plan has a policy of non-intimidation and non-retaliation for good faith reporting of compliance concerns. To learn more about Medicare Fraud: Go to - https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud Source: CMS Outreach and Education MEDIC Golden State Medicare Health Plan is an HMO Plan with a Medicare Contract. Enrollment in Golden State Medicare Health Plan Depends on Contract Renewal. Last Update : 10/14/2021H2241_22WEB-GSMHP-GS1390_M Home| About Us| Contact Us| Privacy Notice| Medicare Complaints © 2021 Golden State Medicare Health Plan