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Report fraud

Health care fraud is a serious issue. Fraud makes health care cost more for everyone. Some forms of health care fraud, waste, and abuse can endanger your health, safety, and well-being. You can help prevent fraud, waste, and abuse.

Health Care Fraud is a dishonest act done on purpose. Examples of fraud are:

  • Letting someone else use your member ID card.
  • Using false information to get medical services or benefits.
  • Getting prescriptions to abuse drugs or sell drugs.
  • Visiting different doctors to get multiple prescriptions for the same drug.
  • Having a provider bill for services you didn’t get.

Committing fraud is a crime. Click here for more information.

Protect yourself from fraud. Anyone can commit fraud, including:

  • Members or their caregivers
  • Medical equipment suppliers
  • Hospital employees
  • Billing services
  • Doctors

How to protect yourself from fraud:

  • Never let someone else use your member ID card.
  • Know who has access to your information, such as a caregiver or relative.
  • Ask your doctors exactly what tests or procedures they want you to have before you have them. And ask them why you need the tests.
  • Track all doctor visits and appointments you attend, miss, or cancel.
  • If you get bills or claims statements for any services, review them and make sure they are correct. (Note: You should not receive bills for benefits covered by Medi-Cal or Santa Clara Family Health Plan (SCFHP) DualConnect )
  • If something is confusing or doesn’t look right on your medical and/or prescription drug Explanation of Benefits (EOB), please call SCFHP at 1-877-723-4795 (TTY: 711), 7 days a week, 8 a.m. to 8 p.m.
  • Beware of “free” medical services.
  • Be careful of anyone who asks for your member ID number, personal identification information, or medical history.
  • If using a computer, completely log out of all password-protected accounts.

Notify SCFHP immediately if:

  • Your card is lost or stolen.
  • A statement shows services, providers, or dates of service that are not correct. (Note: You should not receive bills for benefits covered by Medi-Cal or SCFHP DualConnect.)

If there is a difference between your records and the doctor’s records, it’s not always fraud. It could be a simple error. Call us about the difference so we can review it.

How to report fraud, waste, and abuse

Reporting fraud is everyone’s responsibility. SCFHP takes fraud, waste, and abuse very seriously.

All calls to the SCFHP Fraud Hotline are anonymous and confidential.

If you suspect health care fraud, waste, and abuse, report it to Santa Clara Family Health Plan’s (SCFHP) Compliance Officer. Here’s how you can report:

Be sure to provide as much information as possible. The more information SCFHP receives, the better the Plan will be able to successfully investigate and resolve the issue.

You may also contact the federal agencies below:

California Department of Health Care Services (DHCS)

US Department of Health and Human Services (HHS) - Office of Inspector General

Centers for Medicare & Medicaid Services

Medicare Beneficiary Contact Center
P.O. Box 39
Lawrence, KS 66044

Last updated 12/29/2022