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Prevention and Detection of Fraud, Waste, and Abuse
Vantage is dedicated to improving healthcare in Louisiana. Vantage's efforts to
detect and prevent insurance fraud, waste, and abuse ("FWA") are important
in maintaining the level of service provided to our members.
FWA can cause premium increases, and even the reduction or termination of some benefits.
We believe that early detection and proactive prevention of FWA, through Vantage's
efforts and the efforts of our members and providers, will limit the negative impact
of FWA on the healthcare system and those who access its services.
Fraud, Waste, and Abuse Program
Vantage has developed a Fraud, Waste, and Abuse Program to serve as a guide to assist
those associated with Vantage in preventing, detecting, investigating, and helping
correct conduct which is considered to be fraudulent, wasteful, and/or abusive.
This Program was submitted to the Louisiana Department of Insurance in March 2011
and is available for your review.
 Anti-Fraud Plan
What is Fraud, Waste, and Abuse?
Fraud is an intentional deception or misrepresentation made by a person with the
knowledge that the deception could result in some unauthorized benefit to the person
or others.
Examples of fraud:
- Billing for services or durable medical equipment that was never provided
- Billing for the same service multiple times
- Tampering with claims details
- Identity theft
- Incorrect coding
- Misrepresentation of a member's medical condition (past and present)
- Prescription forging
- Soliciting, offering, or receiving a kickback or bribes
Waste and Abuse can be viewed as spending that can be reduced without impacting
the quality of care received by the member.
Examples of waste and abuse:
- Prescribing medication for 30 days with a refill when it is not known if the medication
will be needed
- Performing and billing an insurance company for laboratory work that is not necessary
Reporting Fraud, Waste, and Abuse
You can help! If you suspect fraud by a provider or member, please report it to
Vantage for investigation.
- Phone: Fraud, Waste, and Abuse Hotline – 888-607-0058
- Email: compliance@vhpla.com
- Fax: (318) 361-2165, Attn: Compliance Department
- Mail: Vantage Health Plan, Compliance Department, 130 DeSiard Street, Ste. 300,
Monroe, LA 71201
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