There is a new hotline link for reporting cases of suspected Fraud, Waste, or Abuse: 

JeffersonHealthPlans.ethicspoint.com

The phone number for making such reports remains the same: 1-866-477-4848. 

Both methods allow for anonymous reporting and are available 24 hours per day, 7 days per week. 

It is best to include the following information when making a report:

• Name of persons involved
• Detailed description of what happened
• Where and when the issue occurred
• Who was present/witnesses
• Provider or Member ID number, if available
• Any supporting documentation, if available

Note: When making a report, be sure to write down the report number and password.  We may need to contact you via the reporting system, and this is the only way that you will be able to receive notifications from us if you don’t choose to leave your contact information.

Federal and state regulations require health plans, providers, and delegated entities to maintain processes to detect, prevent, and report suspected fraud, waste, and abuse. Early reporting helps ensure that potential issues are investigated promptly, protects members and program resources, and supports compliance with Medicaid, CHIP, and Medicare program requirements.  Providers do not need proof that fraud has occurred before making a report. Concerns should be reported whenever there is a reasonable suspicion of improper activity.

Providers should report concerns such as:

• Billing for services that were not performed
• Altered medical records or documentation
• Upcoding or unbundling of services
• Duplicate billing
• Misrepresentation of diagnoses or treatment provided
• Suspected member identity misuse
• Patterns of medically unnecessary services or prescriptions
• Any other activity that appears fraudulent, wasteful, or abusive

If you see something suspicious, report it. Your diligence helps protect our members, our provider network, and the integrity of the healthcare system.