IEHP strives to help resolve any questions or issues members may have. To ensure that our members receive the best care, we need them to report any issues. Issues can be, witnessing any type of fraud, or if a member feels that their personal and private information has been misused.
How Do I Report an Issue?
To report fraud the following resources are available: waste or abuse, privacy issues, and other compliance issues.
Click Report a Compliance Issue to report online.
What is the Privacy Incident/Breach?
IEHP has established a HIPAA Privacy Program to ensure that member’s health information is properly protected, while allowing the flow of health information needed to provide and promote high-quality health care.
What is a privacy breach?
An unauthorized acquisition, access, use, or disclosure of protected health information (PHI) which puts at risk the security or privacy of such information.
PHI is health information that relates to a member’s past, present or future physical or mental health or condition. This includes the services of his/her health care, or payment for that care and contains personally identifiable information (PII) such as name, SSN, DOB, member ID, address, or any other unique identifier related to the member.
This generally means that a breach occurs when PHI is accessed, used, or disclosed to an individual or entity that does not have a business reason to know that information. The law does allow information to be accessed, used, or disclosed when it is related to treatment, payment, or healthcare operations directly associated with the work that we do at IEHP on behalf of our members.
Click Report a Privacy Incident/Breach to report online.
What is the Fraud, Waste, and Abuse (FWA) Program?
IEHP has established a fraud, waste, and abuse program to detect, correct, and prevent fraud, waste, and abuse on part of IEHP employees, IEHP members, providers, vendors, delegated entities and any other entity doing business with IEHP.
What is Fraud?
Fraud is 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.
- The use of someone else's identification or insurance card to obtain services.
- Falsifying income or location to obtain insurance.
- Selling of prescription medication or medical equipment obtained through IEHP.
What is Waste?
Waste includes overuse of services, or other practices that, directly or indirectly, result in unnecessary costs. Waste is generally not considered to be caused by actions of criminal neglect but rather by the misuse of resources.
- Frequent visits to the ER or urgent care for standard doctor visits.
- Visiting multiple doctors or hospitals to obtain controlled medications.
What is Abuse?
Abuse includes actions that may, directly or indirectly, result in unnecessary costs and improper payment or services. 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.
- Use of transportation benefits for non-medical purposes.
Click Report Fraud/Waste/Abuse to report online.