Fraud, Waste, and Abuse hurts everyone.
It can even raise the cost of getting health care services. This is why we need help from our members and providers to find Fraud, Waste, or Abuse and stop it as soon as possible.
How YOU can help prevent Fraud, Waste and Abuse
As our Member, you play an important role in helping us find Fraud, Waste, or Abuse. If you feel that Fraud, Waste, or Abuse might be happening, report it as soon as you can. Here are some examples of possible fraud:
- Someone pretends to be from Gateway Health, Medicare or Social Security and asks for your Social Security number, bank account or credit card numbers, money, etc.
- A health care provider offers you cash or gifts to get free medical care
- A pharmacy bills you for drugs you did not get, or the pharmacy did not give you the right number of pills ordered by your doctor
- You find out someone else is using your health insurance card
- You are billed for health care services or items you did not get
- Your doctor is ordering a lot of tests or items that you do not feel you need
Payment Integrity Definitions
View and download
Laws and Regulations
If you suspect Fraud, Waste, or Abuse, call us at 412-255-4340 or 1-800-685-5235 (TTY Users can call 711 or 1-800-654-5984) so we may look into your concerns.
You have the option to remain anonymous at all times. You do not have to give your name. Gateway has a team of people who look into all calls or mail regarding possible Fraud, Waste, or Abuse of health care services.
To report Medicare or Medicaid Fraud or Abuse you may contact Gateway by mail or phone at:
Gateway Health Plan
Attention: Payment Integrity
Four Gateway Center, Suite 2100
444 Liberty Avenue
Pittsburgh, Pa 15222
Or call the Fraud Hotline at:
412-255-4340 or 800-685-5235
You may also report to the Pennsylvania Department of Human Services (DHS) at:
DHS Bureau of Program Integrity
MA Provider Compliance Hotline
P.O Box 2675
Harrisburg, PA 17105-2675
Or call/fax at:
Medical Assistance Provider Compliance Hotline: 1-866-379-8477
You have the option to remain anonymous at all times.