Fraud, Waste and Abuse

Banner Medicare Advantage is committed to preventing Fraud, Waste, and Abuse (FWA). If you suspect a Banner Medicare Advantage provider or member of fraud, waste or abuse -- please contact Banner Medicare Advantage.

What is Fraud, Waste, and Abuse?

Fraud is purposely giving wrong or misleading information in order to receive a benefit or some type of service.

Waste is over- using services or misusing resources or practices.

Abuse of the Program is provider practices or member practices that result in an unnecessary cost to the Medicare program.

Unfortunately, Fraud, Waste, and Abuse are not as uncommon as you would think. Please see some of the most common examples.

Examples of Fraud and Abuse

Examples of Member Fraud, Waste, and Abuse include, but are not limited to:

  • Lending or selling your Medicare card to anyone.
  • Changing prescriptions written by any Banner Medicare Advantage provider.
  • Using someone else’s Medicare card to obtain services.
  • Giving incorrect information on your Medicare application.
  • Failing to report another insurance that you have.
  • 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 unqualified, unlicensed or has lost their license.
  • Providing unnecessary medical services leading to unnecessary costs to the program.
  • Charging for medical services not provided.
  • Billing multiple payers and receiving double payments.
  • Ordering tests, lab work, or x-rays that aren’t necessary.
  • Using billing codes that pay higher rates to get more money even though those services weren’t provided.
  • Billing for services under a member that is not their member. 

How to Report Fraud, Waste, and Abuse

Anyone can report fraud, waste, or abuse – there are no restrictions. Fraud, Waste, and Abuse hurts everyone. If you suspect a possible case, please report it right away.

If you suspect a provider or member of fraud, waste, and abuse, please contact Banner Medicare Advantage using any of the following methods:

Phone

Customer Care Center: (833) 516-1007; TTY users call 711.

Confidential and Anonymous Compliance (ComplyLine) Hotline: (888) 747-7989; 24 hours a day/7 days a week

Mail

Banner Medicare Advantage
Compliance Department
2701 E. Elvira Road
Tucson, AZ 85756

Fax

Compliance Department: (520) 874-7072

Email

BHPCompliance@bannerhealth.com