Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program.
Waste includes practices that, directly or indirectly, result in unnecessary costs to the Medicare Program, such as overusing services. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources.
Abuse includes actions that may, directly or indirectly, result in unnecessary costs to the Medicare Program. Abuse involves paying for items or services when there is no legal entitlement to that payment, and the provider has not knowingly or intentionally misrepresented facts to obtain payment.
Examples of Fraud:
Examples of Waste:
Examples of Abuse:
Report suspected FWA by mail
Clever Care Health Plan
ATTN: Fraude, Waste, and Abuse
7711 Center Avenue, Suite 100
Huntington Beach, CA 92647
NOTE: Each reporting mechanism listed above are available 24 hours a day, 7 days a week.
Clever Care will not retaliate against you if you inform us, the federal government, state government, or any other regulatory agency with oversight authority of any suspected FWA.