Fraud and Abuse

The vast majority of Medical Assistance (MA) providers and recipients provide and receive care within the boundaries of applicable regulations. Unfortunately, a small number of Medical Assistance recipients and providers engage in practices that are fraudulent or abuse of the Medical Assistance program. Dollars lost to such practices are then unavailable for providing care to those in need. The Department of Public Welfare is committed to eliminating all forms of fraud and abuse within the Medical Assistance program. Your help will enable us accomplish this goal.

You can report suspected fraud and abuse by telephone (1-866-DPW-TIPS), U. S. Mail or email. Reported problems will be referred to the Office of Medical Assistance Program's Bureau of Program Integrity for investigation, analysis and determination of the appropriate course of action. Click on the links below for more information about Medical Assistance fraud and abuse prevention.

Health Care Compliance Plans for Medical Assistance Providers

DPW strongly encourages the adoption of a compliance plan to prevent and detect violations of law or regulations.

MA Bulletins Relating to Program Integrity

Links to MA Bulletins Relating to MA Program Integrity

MA Fraud and Abuse - General Information

Information about Medical Assistance fraud and abuse prevention.

MA Fraud and Abuse/Health Care Compliance Web Sites

Links to various frand and abuse and compliance sites outside of DPW.

MA Provider Compliance Hotline: 1-866-DPW-TIPS

This hotline is designed to provide easy access for reporting suspected fraudulent and abusive practices by providers in fee for service and managed care within the Pennsylvania MA Program.

MA Provider Compliance Hotline: Response Form

Complete this form if you have knowledge of suspected fraud or abuse involving services paid for by the Pennsylvania Medical Assistance Program.

Medical Assistance Provider Self-Audit Protocol

Providers' Voluntary Disclosure of overpayments or improper payments of MA funds.

Medicheck (Precluded Providers) List

Identifies providers, individuals, and other entities who are precluded from participation in the Medical Assistance Program.

MIC Initiative

MIC Initiative

Office of Medical Assistance Program's Privacy Policy

The Office of Medical Assistance Programs closely monitors disclosures of personal health information.

Program Integrity - Post and Prepayment Reviews

DPW is committed to preventing, identifying, and combating fraud and abuse within the MA Program by conducting post payment or prepayment reviews to determine if services were provided and billed in accordance with applicable regulations.