Fraud, Waste, & Abuse

What is Fraud, Waste and Abuse (FWA)?

Fraud is lying about information for you or another person.

Examples of fraud are:

• Letting someone else use your Member ID Card.
• Sending in false claims.
• Lying to get services that you do not need.

Waste is using more than is needed.

Examples of waste include:

• Using or billing for more supplies than needed.
• Using or billing for more technology than needed.
• Using or billing for more hours than needed.

Abuse is providing or accepting products or services that are not needed or are outside normal practices.

Billing for these products or services is an example of abuse.

Fraud, Waste, and Abuse (FWA) can be committed by a member, doctor, or other plan provider.

How to Prevent FWA

You can help prevent FWA by following three easy rules:

1. Protect Your Information

   Only give your Member ID Card to a medical professional that needs it to care for you. Call us as soon as possible if your Member ID Card is lost or stolen.

2. Identify FWA

   Review your plan statements and make sure you and your plan are only being billed for the services you received.

3. Know How to Report

   You can ask a question or report suspected FWA by any of the methods listed below. Remember: a person who tells us about FWA does not have to give their name. Any information you give us is kept private.

   • Call Viva Medicare Member Services at 1-800-633-1542. TTY users call 711. Our call center hours are Monday - Friday, 8 a.m. to 8 p.m. Extended call center hours: October 1 – March 31, 8 a.m. to 8 p.m. seven days a week.

   • Write us:

     Viva Health

     Attn: Compliance Officer

     417 20th Street North, Suite 1100

     Birmingham, Alabama 35203

   • Contact us electronically (using the form below).

   • Call Medicare at 1-877-7SAFERX (1-877-772-3379)

FWA Investigations

If potential FWA is identified, Viva Health will conduct an investigation. If the investigation identifies FWA, we will work with Medicare and law enforcement to correct the issue.