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ArchCare Advantage (SNP) Member Resources

Fraud, Waste and Abuse

ArchCare is committed to detecting and preventing healthcare fraud and abuse. Fraud and abuse in the healthcare system result in higher insurance costs for everyone, including the Medicare and Medicaid programs, individual health plan members, group plans, and business partners, as well as state and federal governments that are funded by taxpayers. ArchCare takes all allegations of fraud and abuse or other compliance issues very seriously.

  • Review your monthly Explanation of Benefits (EOB) to ensure you received all services stated on the document. The EOB is a listing of medications you received, the co-payment you paid and the amount billed to your insurance for the previous month. Look for incorrect dates of service or services you did not receive.
  • Review your Medicare Summary Notice (MSN) and ensure you received all services stated on the document. The MSN shows what Medicare was billed for, what Medicare paid and what you owe.
  • Be sure to protect your membership card, as it contains information regarding your benefits.
  • Beware of providers who use pressure tactics to convince you to accept a certain product or service.
  • Only allow appropriate medical professionals to review medical records or recommend services.
  • Stay informed about your Medicare/Medicaid and/or other insurance benefits.
  • Always keep proof of any payments you make to a healthcare provider.

Reporting Healthcare Fraud‚ Waste and Abuse

If you have a reason to believe a healthcare provider is performing unnecessary or inappropriate services or is billing for services not given to you, you should report this immediately. Your report may be made confidentially.

To report any fraud, waste or abuse, please contact ArchCare by filling out our online reporting form or calling the Fraud, Waste and Abuse Hotline toll-free at 800-443-0463.

Medicare Fraud

Protecting Medicare and You From Fraud