Fraud, Waste, & Abuse
Banner – University Care Advantage (B – UCA) is committed to preventing Fraud, Waste, and Abuse (FWA). If you suspect a B – UCA provider or member of fraud, waste or abuse -- please contact B – UCA.
Fraud, Waste, and Abuse Defined
- Fraud – 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 – Overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to federal and state government programs. Waste is generally not considered to be criminally negligent but rather the misuse of resources.
- Abuse – Includes actions that may, directly or indirectly, result in: unnecessary costs to the Medicare or Medicaid programs or other government programs, improper payment, payment for services that fail to meet professionally recognized standards of care, or services that are medically unnecessary. Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment.
Examples of Fraud and Abuse
Examples of Member Fraud, Waste, and Abuse include but are not limited to:
- Lending or selling your Medicaid or Medicare card to anyone.
- Changing prescriptions written by any B – UCA provider.
- Giving incorrect information on your Medicare application.
- Providing false materials or documents.
- Leaving out important information.
Examples of Provider Fraud, Waste, and Abuse include but are not limited to:
- Use of the Medicare system by someone who is inappropriate, unqualified, unlicensed or has lost their license.
- Providing unnecessary medical services leading to unnecessary costs to the program.
- Charging for medical services not rendered.
- Not meeting professional standards for health care.
How to Report Fraud, Waste, and Abuse
If you suspect a provider or member of fraud, waste, and abuse -- please contact us using any of the following methods:
Customer Care Center: (877) 874-3930; TTY users should dial 711
Compliance Department: (520) 874-5075
ComplyLine (anonymous): (888) 747-7989; 24 hours a day/7 days a week
Banner – University Care Advantage
Compliance and Audit Department
2701 E. Elvira Road
Tucson, AZ 85756
Compliance Department: (520) 874-7072