Fraud & Abuse Hotline

Protect Yourself and the Medicare Program from Billing Fraud

Gateway Health Plan^® is working with our members, providers and other governmental agencies to protect you and the Medicare Program from Medicare fraud. Medicare fraud occurs when you or Gateway Health Plan^® is billed for services you never received.  A fraud scheme can be carried out by individuals, companies, or groups of individuals.

If you suspect billing fraud, you can call

1. Your healthcare provider to be sure the billing is correct or,
2. Gateway Health Plan^®'s Fraud and Compliance Hotline 1-800-685-5235 or
3. 1-800-MEDICARE (1-800-633-4227; TTY users should call 1-877-486-2048), or
4. The Office of Inspector General's hotline 1-800-HHS-TIPS (1-800-447-8477).

When you receive health care services, you receive an Explanation of Benefits (EOB) from Gateway Health Plan^®.  This EOB shows what services or supplies were charged and how much Gateway Health Plan^® paid.  Please check the EOB for mistakes, and make sure the services or supplies that you received are correct.  If you see a charge on your EOB that you feel may be wrong, call your health care provider, and ask about it.  The bill may be correct, and the person you speak to may help you to better understand the services or supplies you received.  Or, through your review of the EOB, you may discover a billing error that needs to be corrected.  If you aren't satisfied with the provider's response, call Gateway Health Plan^®'s Fraud and Compliance hotline at 1-800-685-5235.  All calls to this line are investigated and callers may remain anonymous.

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