Reporting fraud

Sharp Direct Advantage^® takes allegations of fraud and abuse seriously. If you think that you have been a victim of fraud or abuse or are aware of such instances, we encourage you to report your concern.

Recognizing fraud, waste and abuse and non-compliance

Protect your identity by knowing the signs of fraudulent schemes and questionable offers involving Medicare. An identity thief might try to use your Medicare information to get paid for care you never received.

• Look out for people asking for your Medicare claim number or other plan information, or who offer bribes if you will see an unfamiliar doctor or use services you don’t need.
• Examples of fraud include:
  • Altering claims to obtain higher payments
  • Soliciting, offering or receiving a kickback, bribe or rebate
  • Using another person’s Medicare card to obtain care
• This is an example of abuse:
  • A provider prescribing prescriptions that aren’t medically necessary.
• Sharp Health Plan will not contact you by phone to offer free diabetic or medical supplies. Unfortunately, scammers may sometimes offer free supplies in order to ask for your birth date, insurance ID, Medicare number or other personal information. If you get a call like this one, do not provide any information.

Please report your concerns using the information below.

Reporting fraud

If you suspect fraud, abuse or waste, contact us immediately. Call our Regulatory Affairs Department at 1-858-499-8237. Or, send a letter to:

Sharp Direct Advantage
Fraud and Abuse Investigations
8520 Tech Way Suite 201
San Diego CA  92123

You can help us stop health care fraud.

You do not have to give your name. Just tell us why you think fraud is occurring. Give us the name of the provider or member, and tell us what you are worried about. We take your questions and input seriously. Every effort will be made to protect your identity. There will be no retaliation for good faith reporting.

Additional contact information for reporting fraud

You may also contact Medicare directly with concerns about Medicare Advantage plans or Medicare Prescription Drug Plans.

Privacy practices

The Health Insurance Portability and Accountability Act’s (HIPAA) medical privacy regulations govern the use and release of a patient’s personal health information, also known as Protected Health Information (PHI). In the event that state law or hospital policy is more restrictive than the HIPAA privacy regulations, the more restrictive law or policy will apply.

Under the HIPAA privacy regulations, patients must be informed about how their PHI will be used and given the opportunity to object to or restrict the use or release of their information.

Sharp Direct Advantage is offered by Sharp Health Plan. Sharp Health Plan is an HMO with a Medicare contract. Enrollment with Sharp Health Plan depends on contract renewal. Read the full disclaimer.

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