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Prescription drug abuse is an ongoing problem. Not only does it have a
significant societal impact, it drives up the cost of health insurance
premiums. The AmeriHealth Corporate and Financial Investigations Department
(CFID) is committed to reducing prescription drug fraud, waste, and abuse
(FWA). Safeguards are in place to limit dispensing quantities and to make sure
that the drug is medically necessary. Most of the drugs that are misused are
opioid pain relievers with a high street value.
Addicted individuals will often use fraud to obtain these drugs. This
includes:
- Doctor shopping. Visiting multiple doctors to obtain multiple
prescriptions for the same complaint on a monthly basis.
- Pharmacy shopping. Using multiple pharmacies to fill different
prescriptions for the same drug.
- Unnecessary ER visits. Unnecessary emergency room/department (ER)
visits for the sole purpose of obtaining more drugs.
- Forgery. Forged prescriptions
If you suspect prescription drug or health care fraud against you and/or
AmeriHealth, we urge you to report it. All reports are confidential. You are
not required to provide your name, address, or other identifying
information.
Submitting a fraud report
You have three options for submitting a fraud report:
- Web. Submit a report electronically using the Online Fraud &
Abuse Tip Referral Form.
- Phone. Call the confidential anti-fraud and corporate compliance
toll-free hotline at 1-866-282-2707 (TTY: 1-888-789-0429).
- Mail. Write a description of your complaint, enclose copies of any
supporting documentation, and mail it to:
AmeriHealth
Corporate & Financial Investigations Department
1901 Market Street, 42nd Floor
Philadelphia, PA 19103
As a result of CFID's efforts, last year $7.3 million was recovered in
FWA-related claims and 18 fraud cases were referred to law enforcement or
regulatory agencies. Multiples of the recovered amount were saved through the
detection, prevention, and shutting down of improper payments and schemes. Many
of these recoveries and referrals started with information someone provided to
CFID. Please join us in the fight against health care and prescription drug
fraud.
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