Fraud, Waste and Abuse

Health care fraud, waste and abuse is a national problem that affects all of us either directly or indirectly. National estimates project that billions of dollars are lost to health care fraud, waste and abuse on an annual basis. These losses lead to increased health care costs and potential increased costs for coverage.

Health care fraud is an intentional misrepresentation, deception, or intentional act of deceit for the purpose of receiving unwarranted payment in part or in whole.

Health care abuse is reckless disregard or conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in unnecessary costs.

All information received is strictly confidential. Please notify Paramount if you suspect healthcare fraud, waste or abuse against the company by using the following resources:

  • Contact Paramount's Member Services Department for a confidential discussion at 419-887-2525 or toll free at 800-462-3589.
  • TTY services for the hearing-impaired are available at 888-740-5670 or 419-887-2526.
  • You can contact the Compliance Hotline at 1-800-553-1000.
  • Writing a letter to the Paramount mailing address:

    Paramount Health Care
    Attn: Director, Regulatory Compliance
    300 Madison Avenue, Suite 270
    Toledo, OH 43604

  • Email Address: Paramount.MemberServices@MedMutual.com
  • Confidential fax number: (419) 887-2037

When reporting suspected fraud, please remember to include the names of all applicable parties involved. Specify which person you believe is committing the fraud, identify the dates of service or issues in question and describe in detail why you believe a fraudulent act may have occurred.

If possible, please include your name and telephone number so we may contact you if we have any questions during our investigation.

Provider Fraud

  • Billing for services not rendered
  • Altering medical records
  • Use of unlicensed staff
  • Drug diversion (e.g. dispensing controlled substances with no legitimate medical purpose)
  • Kickbacks and bribery
  • Providing unnecessary services to members

Member Fraud

  • Falsification of information
  • Forging or selling prescription drugs
  • Using transportation benefit for non-medical related business (Advantage)
  • Adding an ineligible dependent to the plan
  • "Loaning" or using another person's insurance card
  • Identity Theft

Broker and Agent Fraud

  • Alteration of documents
  • Bribery and kickbacks
  • Falsification or misrepresentation of member and or group information to obtain reasonable rates. This act makes the applicant for coverage appear to be a better risk for policy acceptance.
  • Failure to disclose information that may affect conditions of coverage
  • Sale of non-existent policies

Part D Medicare Prescription Drug Benefit Fraud, Waste or Abuse

  • An individual or organization pretends to represent Medicare and/or Social Security, and asks you for your Medicare or Social Security number, bank account number, credit card number, money, etc.
  • Someone asks you to sell your Medicare prescription drug card
  • You feel a Medicare prescription Drug Plan has discriminated against you, including not letting you sign up for their plan because of your age, health, race, religion, income
  • You were encouraged to disenroll from your plan
  • You were offered cash to sign up for a Medicare prescription drug plan
  • You were offered a gift worth more than $15 to sign up for a Medicare prescription drug plan
  • Your pharmacy did not give you all of your drugs
  • You were billed for drugs that you didn't receive
  • You believe that you have been charged more than once for your premium costs
  • Your Medicare prescription drug plan did not pay for your covered drugs
  • You received a different drug than your doctor ordered

Anti-Fraud Contact Information

Additional links for questions relating to Fraud on HSA accounts:

NOTE: Paramount is providing the above links because they may be of interest or useful to you. Paramount does not own, control, or influence these sites, and is not responsible for their content.