UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan

Use the documents below to learn more about each important health topic.

Fraud, Waste, and Abuse

Healthcare fraud, waste and abuse affects everyone. Combating it begins with awareness. Fraud is committed when a dishonest provider or consumer intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits. Waste is the over-utilization of services not caused by criminally negligent actions and the misuse of resources. Abuse is provider practices that are inconsistent with professional standards of care: medical necessity, or sound fiscal, business, or medical practices and provider or beneficiary practices that result in unnecessary costs to the healthcare program.

What is provider fraud, waste and abuse?
  • Billing for services not rendered
  • Upcoding (billing for more expensive services or procedures than were actually provided or performed)
  • Soliciting, offering or receiving kickbacks
  • Improper or sloppy billing practices
  • Failure to maintain adequate records
  • Routine waiver of coinsurance and deductible

What is member fraud, waste and abuse?

  • Loaning or using another person's insurance card
  • Forging or selling prescription drugs
  • Providing false information when applying for program benefits

UnitedHealthcare Community Plan is committed to combating fraud, waste and abuse. If you suspect health care fraud, waste and abuse, you may report via the following methods:

  • Anonymous fraud, waste and abuse hotline: 1.877.766.3844

Clinical Health Guidelines

Perinatal Care

American Academy of Pediatrics and The American College of Obstetricians and Gynecologists, Sixth Edition, Guidelines for Perinatal Care
Click Here (PDF 394.85 KB)

Preventive Pediatric Health Care Screening

2009 Recommendations for Preventive Pediatric Health Care screening guidelines (periodicity schedule) from the American Academy of Pediatrics

American Academy of Pediatrics
http://brightfutures.aap.org/pdfs/AAP%20Bright%20Futures%20Periodicity%20Sched%20101107.pdf

Preventive Services Guideline

2010-2011 Guide to Clinical Preventive Services – US Preventive Services Task Force (USPSTF)

Agency for Healthcare Research and Quality
http://www.ahrq.gov/clinic/pocketgd.htm

Pregnancy

Healthy First Steps (PDF 1.7 MB)

Questions and Answers

2011 Flue Q&A (PDF 18.59 KB)
2011 Pneumonia Q&A (PDF 18.88 KB)

Other

Asthma Action Plan (PDF 172.95 KB)
Coronary Artery Disease Health Log (PDF 178.51 KB)
COPD Action Plan (PDF 164.76 KB)
Diabetes Health Log (PDF 242.77 KB)
Heart Failure Health Log (PDF 241 KB)
Lead Poisoning (PDF 142.79 KB)
Taking Charge of Your Ashthma (PDF 496.51 KB)
Taking Charge of Your COPD (PDF 455.12 KB)
Taking Charge of Your Depression (PDF 254.15 KB)
Taking Charge of Your Diabetes (PDF 1.93 MB)
Taking Charge of Your Heart Disease (PDF 432.1 KB)
Taking Charge of Your Heart Failure (PDF 517.98 KB)

Member Newsletters

Summer 2013 Issue (English) (PDF 1.28 MB)
Summer 2013 Issue (Español) (PDF 1.26 MB)
Spring 2013 Issue (English) (PDF 631.94 KB)
Spring 2013 Issue (Español) (PDF 619.89 KB)
Fall 2012 (PDF 780.75 KB)
Fall 2012 Español (PDF 680.29 KB)
Summer 2012 (PDF 575.27 KB)
Summer 2012 Español (PDF 621.07 KB)
Spring 2012 (PDF 731.48 KB)
Spring 2012 Español (PDF 669.95 KB)
Winter 2012 (PDF 726.2 KB)
Winter 2012 Español (PDF 689.48 KB)
Fall 2011 (PDF 1.24 MB)
Fall 2011 Español (PDF 765.57 KB)
Summer 2011 (PDF 561.42 KB)
Summer 2011 Español (PDF 523.8 KB)
Spring 2011 (PDF 522.36 KB)
Spring 2011 Español (PDF 437.31 KB)
Winter 2010-2011 (PDF 1.19 MB)