2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Complete (PPO) Chapter 11: Legal notices 243 Section 13 2024 Enrollee Fraud & Abuse Communication 2024 Enrollee Fraud & Abuse Communication How you can fight healthcare fraud Our company is committed to preventing fraud, waste, and abuse in Medicare benefit programs and we’re asking for your help. If you identify a potential case of fraud, please report it to us immediately. Here are some examples of potential Medicare fraud cases: · A health care provider - such as a physician, pharmacy, or medical device company - bills for services you never got; · A supplier bills for equipment different from what you got; · Someone uses another person’s Medicare card to get medical care, prescriptions, supplies or equipment; · Someone bills for home medical equipment after it has been returned; · A company offers a Medicare drug or health plan that hasn’t been approved by Medicare; or · A company uses false information to mislead you into joining a Medicare drug or health plan. To report a potential case of fraud in a Medicare benefit program, call UnitedHealthcare® Group Medicare Advantage PEBB Complete (PPO) Customer Service at 1-855-873-3268 (TTY 711), 8 a.m.-8 p.m. local time, Monday-Friday. This hotline allows you to report cases anonymously and confidentially. We will make every effort to maintain your confidentiality. However, if law enforcement needs to get involved, we may not be able to guarantee your confidentiality. Please know that our organization will not take any action against you for reporting a potential fraud case in good faith. You may also report potential medical or prescription drug fraud cases to the Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SafeRx (1-877-772-3379) or to the Medicare program directly at (1-800-633-4227). The Medicare fax number is 1-717-975-4442 and the website is medicare.gov. Section 14 Commitment of Coverage Decisions UnitedHealthcare’s Clinical Services Staff and Physicians make decisions on the health care services you receive based on the appropriateness of care and service and existence of coverage. Clinical Staff and Physicians making these decisions: 1. Do not specifically receive reward for issuing non-coverage (denial) decisions; 2. Do not offer incentives to physicians or other health care professionals to encourage inappropriate underutilization of care or services; and 3. Do not hire, promote, or terminate physicians or other individuals based upon the likelihood or the perceived likelihood that the individual will support or tend to support the denial of benefits. Section 15 Renew Active®Terms and Conditions