It can even raise the cost of getting health care services. This is why we need help from our members and providers to find Fraud, Waste, or Abuse and stop it as soon as possible.
How YOU can help prevent Fraud, Waste, and Abuse
As our Member, you play an important role in helping us find Fraud, Waste, and Abuse. If you feel that Fraud, Waste, or Abuse might be happening, report it as soon as you can.
Here are some examples of possible Fraud:
Review and identify the providers responsibilities as they relate to Fraud, Waste, and Abuse (“FWA”).
WATCH VIDEO
See disclaimer below 1
VIEW OR DOWNLOAD 2025 PROVIDER FRAUD, WASTE AND ABUSE TRAINING picture_as_pdf
Provider Compliance Assessment Training
Highmark Wholecare’s Financial Investigations and Provider Review (FIPR) Division breaks down the purpose and value of the Provider Compliance Plan and how to complete the Provider Compliance Assessment, an integral part of an effective Compliance Plan.
WATCH VIDEO
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Provider Training Breaking Down Behavioral Health: Coding Concepts
VIEW OR DOWNLOAD 2024 PROVIDER COMPLIANCE ASSESSMENT TRAINING picture_as_pdf
VIEW OR DOWNLOAD FRAUD, WASTE AND ABUSE picture_as_pdf
VIEW OR DOWNLOAD 2025 PROVIDER FRAUD, WASTE AND ABUSE TRAINING picture_as_pdf
VIEW OR DOWNLOAD LAWS AND REGULATIONS picture_as_pdf
VIEW OR DOWNLOAD 2025 FRAUD, PREVENTION AND DETECTION PLAN picture_as_pdf
VIEW OR DOWNLOAD 2023 PROVIDER TRAINING ON DMEPOS picture_as_pdf
VIEW OR DOWNLOAD AUDIT PLAN SUPPLEMENTAL GUIDE picture_as_pdf
If you suspect Fraud, Waste, or Abuse, call us at 1-844-718-6400 (TTY Users can call 711 or 1-800-654-5984) so we may look into your concerns. You can also use the online form to report suspected Fraud, Waste, or Abuse.
Delivery Code: FIPR
Highmark Wholecare
Attn: FWA/SIU Unit
120 Fifth Ave
Pittsburgh, PA 15222
Or call the Fraud Hotline at: 1-844-718-6400
Department of Human Services
Office of Administration
Bureau of Program Integrity
P.O. Box 2675
Harrisburg, PA 17105-2675
Or call 1-866-DHS-TIPS (1-866-379-8477)
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