What is Fraud, Waste and Abuse (FWA)?
Fraud is an intentional misrepresentation that may result in unauthorized costs to a healthcare program.
Abuse is a practice that is inconsistent with sound medical or business practices that may directly or indirectly result in unnecessary costs to a healthcare program.
Waste is the inappropriate use of healthcare funds or resources without a justifiable need to do so.
There are differences between Fraud, Waste, and Abuse. These differences are based upon intent and knowledge. Fraud requires the person to have an intent to obtain payment and the knowledge that their actions are wrong. Waste and Abuse may involve obtaining an improper payment, but does not require the same intent and knowledge.
Eliminating FWA in the delivery of healthcare is an obligation, responsibility, and legal requirement of all SCAN Health Plan employees and the plan’s contracted providers.
For More Information: Fraud and Member Protection Resources
How to Report Fraud, Waste and Abuse (FWA)
To report suspected fraud, waste and abuse (FWA), you may contact SCAN in one of these ways:
- SCAN Hotline on EthicsPoint: 1-877-863-3362 or visit www.ethicspoint.com
- Email: FraudWaste&AbuseProg@scanhealthplan.com
- Call: SCAN Health Plan Member Services, at 1-800-559-3500 (TTY User: 711) 8:00 a.m. – 8:00 p.m. PST – Monday – Friday, 9:00 a.m. – 4:00 p.m. – Saturday. Messages received on holidays and outside of our business hours will be returned within 1 business day. They will file a report with our Special Investigations Unit team.