NARBHA Corporate Compliance
UNDERSTANDING HEALTH CARE FRAUD
It is estimated that over $60 billion in healthcare fraud occurs each year, or about 3% of healthcare expenditures.
NARBHA embraces and adheres to the highest organizational business and professional practice standards consistent with applicable State and Federal law, regulatory and contractual requirements, in an effort to eliminate healthcare fraud, waste and abuse within our network, across Northern Arizona.
Healthcare fraud is an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in come unauthorized benefit to themselves or others.
Healthcare program abuse is when a provider's practices are inconsistent with sound fiscal, business or medical practices and result in an unnecessary cost to the Medicaid (AHCCCS) program.
Examples of healthcare fraud and abuse:
- Using someone else's medical insurance information to obtain services or supplies;
- Charging for a service not provided;
- Overcharging for a service or product provided;
- Delivering less than the service or product promised;
- Charging for a product or service and then providing an item that is worth a lesser amount;
- Falsifying signatures or medical records to support misrepresented services or supplies.
If you are aware of suspected fraud or abuse involving a NARBHA member of provider, please report it. If you are unsure about whether something is fraud or abuse, please report it and we will work to explore whether it is potential fraud or abuse. NARBHA refers all instances of fraud and abuse to state agencies for further investigation.
We appreciate your support and partnership while we keep the NARBHA system one of the highest integrity, and one free of fraud and abuse.
NARBHA's Corporate Compliance Officer
REPORT FRAUD & ABUSE
Call the Hotline
1300 South Yale Street
Flagstaff, AZ 86001
Attn: Corporate Compliance Officer