As a community health plan that values partnership, service excellence, and relationships, we are committed to doing the right thing. We have Compliance and Fraud, Waste, and Abuse (FWA) programs that we follow to ensure we comply with State and Federal laws, regulations, and our internal policies and procedures.
- A provider charging you for a service covered by PacificSource Community Solutions
- A provider billing for services that you did not receive
- A provider giving you a service that you do not need based on your health condition
- Going to multiple doctors for prescriptions for a drug already prescribed to you
- Someone using another person’s ID to get benefits
- Training and education
- Code of Conduct
- Policies and procedures
- Compliance Officer and Compliance Committee
- Monitoring and auditing
- How to report issues
- How we look into and resolve issues
- How we correct issues
Below are documents and websites with tips and important information on how to protect yourself against fraudulent activities. This includes how to spot fraud and how to report your concerns.
- Oregon Health Authority Office of Program Integrity
This government website provides information on Medicaid fraud, including how to spot and report your concerns.
- General information about scams and fraud
This government document provides tips on how to prevent identity theft.
- US Department of Justice Website
This government website provides news and updates on national healthcare fraud.
- Office of Inspector General Website
This government website provides news and updates on national healthcare fraud, including law enforcement actions taken against fraudulent parties.