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UnitedHealthcare Community Plan
UnitedHealthcare Community Plan

Pennsylvania – UnitedHealthcare Community Plan for Families - Member Information

Fraud and Abuse

UnitedHealthcare Community Plan has a hotline if you want to report a medical provider (for example, a doctor, dentist, therapist or hospital) or business (for example, a medical supplier) if you think there is fraudor abuse. You can call the UnitedHealthcare Community Plan fraud and abuse hotline at 1-877-401-9430. Some examples of fraud and abuse are:

  • Billing or charging you for services that your health plan covers.
    Offering you gifts or money to receive treatment or services.
    Members loaning their ACCESS or UnitedHealthcare Community Plan ID cards to another person
    to get services using the member’s name.
  • Offering you free services, equipment or supplies in exchange for your ACCESS number.
  • Giving you treatment or services that you do not need.
  • Physical, mental or sexual abuse by medical staff.
  • Being offered prescription or prescription medications without being seen or treated by the
    prescribing doctor.
  • A member who visits an unusually high number of doctors to obtain narcotic drugs.

DHS also has a Medical Assistance Provider Compliance hotline that you can reach by dialing
1-844-DHS-TIPS (1-844-347-8477), Monday through Friday, 8:30 a.m. to 3:30 p.m. You may
leave a voice-mail message at other times. You can also report suspected fraud and abuse by visiting
http://www.dhs.state.pa.us/learnaboutdhs/fraudandabuse or emailing omaptips@state.pa.us. You don’t have to give your name. If you do, the provider won’t be told that you called. If you don’t speak English, an interpreter will be made available. If you are hearing-impaired, you can call the hotline using your TTY device.

Review your policy and benefits statements.

Review the paperwork you receive related to your health care coverage. Make sure you received the
treatments for which your health plan was charged, and question suspicious expenses.

Protect your health plan ID card like your credit card.
In the wrong hands, a health plan ID card is a license to steal. Don’t give policy numbers to door-to-door
salespeople or telephone solicitors. Never give your card to a friend to use for medical services. Help control the cost of health insurance by reporting suspect behavior. Join the effort to fight fraud and abuse in the health care system.

If you aren’t sure, call us. You can make us aware of potential fraud via our helpline.