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UnitedHealthcare Community Plan

Member Information

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

Preventive Services Guideline

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

Agency for Healthcare Research and Quality
Click Here

For a description of the UnitedHealthcare practice guidelines, please write to:
UnitedHealthcare Community Plan Quality Improvement
9200 Worthington Road, 3rd Floor
Westerville, Ohio 43082

Pregnancy

Text4Baby logo

Text4baby gets you free facts for you and your baby. To help give you and baby a great start click here to sign up.

Member Newsletters


Fall 2017 Issue English (PDF 444.8 KB) | Español (PDF 431.62 KB)
Summer 2017 Issue English (PDF 407.11 KB) | Español (PDF 389.59 KB)
Spring 2017 Issue English (PDF 479.04 KB) | Español (PDF 467.17 KB)
Winter 2017 Issue English (PDF 627.6 KB) | Español (PDF 571.44 KB)
Fall 2016 Issue English (PDF 380.87 KB) | Español (PDF 364.38 KB)
Summer 2016 Issue English (PDF 512.31 KB) | Espano (PDF 870.07 KB)l
Spring 2016 Issue English (PDF 515.98 KB) | Español (PDF 507.97 KB)

Winter 2016 Issue English (PDF 626.64 KB) | Español (PDF 588.59 KB)
Fall 2015 Issue English (PDF 1.92 MB) | Español (PDF 435.2 KB)
Summer 2015 IssueEnglish (PDF 903.39 KB) | Español (PDF 860.6 KB)
Spring 2015 Issue English (PDF 746.6 KB) | Español (PDF 762.68 KB)
Winter 2015 Issue English (PDF 772.17 KB) | Español (PDF 812.46 KB)
Fall 2014 Issue English (PDF 2.24 MB) | Español (PDF 2.09 MB)
Summer 2014 Issue English (PDF 692.63 KB) | Español (PDF 2.09 MB)
Spring 2014 Issue English (PDF 647.65 KB) | Español (PDF 571.04 KB)
Winter 2013 Issue (PDF 1.41 MB)
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)

Member Advisory Council and Connected Advisors Updates

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

Q&A

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

Other

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1-800-895-2017
TTY: 711

7 a.m. to 7 p.m.
Monday through Friday.

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Member Information

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