file medicaid complaint

By communicating with Superior through email, you accept the risks associated thereof. If you think that your health care provider shared your personal health information with someone else, without your permission, please visit the Office for Civil Rights HIPAA website at http://www.hhs.gov/ocr/hipaa/ or contact them at 1-866-627-7748. WebFile a Medicaid fraud complaint. Adult Behavioral Health & Developmental Disability Services. Who is the patient/resident? Name and contact information of the individual or business related to your complaint. Authorization Form. T: (717)705-6938 F: (717)787-1190. WebFile a complaint at Medicare.gov or call 1-800-MEDICARE Allegations by HHS employees of discrimination on the basis of race, gender, ethnicity, religion or sexual preference. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. There is no time limit for filing a complaint with Superior. Your Child Support And The Federal Stimulus Payment, How to Request an Attorney General Opinion, Office of the Attorney Generals Medicaid Fraud Control Unit Sends Owner of Home Health Company to Prison for, Paxtons Medicaid Fraud Control Unit Helps Secure Swift Conviction of Healthcare Marketer for Illegal Kickback Scheme, Paxton Secures Justice with Eight-Year Prison Sentence for Ambulance Owner Who Perpetrated $, Texas Attorney Generals Medicaid Fraud Control Unit Helps Take Down $6.9 Million Medicaid Fraud Scheme. To file an Administrative Simplification HIPAA-related paper complaint rather than an electronic one, please complete this OMB-approved form 0938-0948 and Programs for healthy children & families, including immunization, lead poisoning prevention, prenatal smoking cessation, and many others. What Next When your complaint is received at the Department it will be assigned a case number and you will receive an acknowledgement letter. WebMedicaid Director Office of Health Insurance Programs The Medicaid Update is a monthly publication of the New York State Department of Health Office of the Medicaid Inspector General: For suspected fraud, waste or abuse complaints/allegations, call 1-877-87FRAUD, (877) 873-7283, or visit Office of Medicaid Inspector General (OMIG) web site. [ If you believe an entity is not complying with the Federal Independent Dispute Resolution process, or you want to report a violation of the protections of the No The Department also investigates allegations or harm or potential harm due to an unsafe physical (building) environment. Problems with self-insured plans must be addressed by the Federal Department of Labor. Who should I contact? June 30, 2023. Is it possible to request a different caseworker? W196, Indianapolis, IN 46204, unless there has been an award. The Department is an administrative agency of State Government and cannot act in the capacity of a court. This can include billing for services not rendered, billing for unnecessary services, and exaggerating (upcoding) the services or products provided. June 30, 2023. Whistleblower retaliation. Download the EMS and Trauma Systems Complaint Intake Form. To ensure the safety of your protected health information (PHI), please send us a message through the Secure Member Portal or Provider Portal, or you can call us at the Member Services number on the back of your Superior ID card to speak directly to a customer service representative. If you think a health care provider or a Medicaid recipient has intentionally misused someones Medicaid coverage to receive services they should not have received, please contact the fraud and abuse hotline at 1-888-419-3456, or submit a Medicaid Fraud and Abuse Complaint using the online Fraud Complaint Form. You can also complain to the Texas Health and Human Services Commission (HHSC) by calling toll-free at 1-800-252-8263. Central Complaint Registry Hotline - 800-252-4343 In Texas, Medicaid costs taxpayers I don't know who my worker is. WebInside MDHHS Complaints File a Medicaid Fraud Complaint File a Welfare Fraud Complaint File a WIC Fraud or Abuse Complaint File a WIC Vendor Complaint File a Complaint Against a Body Art Facility Universal Caseload Issues How do I know if my county office is currently a Universal Caseload (UCL) office? 251.8 kB This review will determine if there are potential violations of those requirements and if this is the office with jurisdiction to take further action. Fax: (609) 777-0508 or (609) 292-2431. Consult the guidelines for the particular program, Appeals of judicial decisions by federal or state courts involving HHS programs. Health Care Coverage information and resources. ] A lock ( LockA locked padlock ) or https:// means youve safely connected to the .gov website. Download the Member Complaint form (PDF) or Provider Complaint form (PDF), print and mail or fax the completed form to: Superior HealthPlan Information on the Family Independence Program, State Disability Assistance, SSI, Refugee, and other cash assistance. PhRMA has filed a lawsuit to stop Medicare's drug price negotiation program. Mail to: IDOI. TTY for the Hearing Impaired Only- 800-547-0466, Health Care Facilities Complaint Form Information & resources for Community and Faith-Based partners. Printable Provider Complaint Form ( PDF) Online Complaint Form. Complaints submitted to this site are limited to hospitals, home health agencies, hospices, end-stage renal dialysis units, ambulatory surgical treatment centers, rural health clinics, critical access hospitals, clinical laboratories (CLIA), outpatient physical therapy, portable X-ray services, community mental health centers, accredited mental health centers (only Medicare Certified), comprehensive outpatient rehabilitation facilities, Free Standing Emergency centers, alternative health care delivery and health maintenance organizations (HMOs). The investigation was conducted by Sergeant Alfred Paige, Investigative Auditor Daryl Middleton, and Captain Alexander Chancia of the Texas Attorney Generals Medicaid Fraud Control Unit (MFCU), in cooperation with the FBI and the Department of Health and Human Services - Office of Inspector General. 525 W. Jefferson St., Ground Floor You can find links to the forms you will need to fill out at theDHS website. The OAGs Medicaid Fraud Control Unit is dedicated to ensuring that those who exploit our healthcare system for personal gain are brought to justice by aggressively pursuing those who engage in healthcare fraud, working to safeguard taxpayer funds, and defending the integrity of vital healthcare programs. Plans must maintain a complete and accurate record of all complaints and share this information with Agency. Contact your agency's Equal Employment Opportunity officer, Allegations by employees or applicants concerning prohibited personnel practices; or Hatch Act violations. Information on Adult Protective Services, Independent Living Services, Adult Community Placement Services, and HIV/AIDS Support Services. For every dollar of state funding, the OAGs MFCU recovers more than 33 dollars for taxpayers. Information about the Michigan law that requires certain information be made available to a woman who is seeking an abortion at least 24 hours prior to the abortion procedure. We will then suggest the appropriate resolution to the problem and take the administrative action when appropriate. For non-long term care complaints contact the Departments Division of Health Care Facilities and Programs at 217-782-7412. Children's Special Health Care Services information and FAQ's. Contact the Management of the relevant agency, Fraud relating to Social Security. Information on DHS Applications and Forms grouped by category. If I am not a member of a case how can I get information about a case. The complaint systems are designed to protect anonymity and in most circumstances this office is prohibited from releasing complainant information. WebTo file a complaint about your doctor (like unprofessional conduct, incompetent practice, or licensing questions), contact your State medical board. June 30, 2023. If you speak another language or are hearing impaired and need help, please call Superior Member Services. The coalition of attorneys general, led by Kansas Attorney Providers: submit a billing complaint. The Department will review the complaint information and the companys explanation to determine whether the company is justified in their actions or not. Las Vegas, NV Today, Attorney General Aaron D. Ford announced that Joy Behavioral Health, LLC (Joy) and its owner Edward Gamboa was sentenced in a Medicaid fraud case involving billing for services that were not provided to Medicaid recipients. You will have thirty (30) days from the date of the denial letter to appeal the decision. HIPAA violations. If you think a health care provider is committing Medicaid billing fraud, please contact the fraud and abuse hotline at 1-888-419-3456, or submit a Medicaid Fraud and Abuse Complaint using the online Fraud Complaint Form. Create an account with the Health Insurance Marketplace and Accessibility Issues. In less than three months, the federal government is set to announce the initial 10 drugs subject to first-ever price negotiations in Medicare. The defendants are charged with defrauding the Medicaid program through illicit practices committed through the Floss Family Dental Care clinic in Houston. In 2018, Cork Review the Self-Disclosure information. Information on resources in your community and volunteer recruitment and training, and services provided at local DHS offices. The enrollee must file the grievance either verbally or in writing no later than 60 days after the triggering event or incident precipitating the grievance. To file a complaint about improper care or unsafe conditions in a hospital, home health agency, hospice, or nursing home, contact your State Survey Agency. Trenton, NJ 08625-0475. Policy information (insureds name, patients name, group/member/policy numbers). The Statewide Medicaid Managed Care program ITN is released! If you have a complaint about the quality of care youre getting from a home health agency, call the home health agency and ask to speak to the administrator. Report it to USDA OIG, Self-Disclosures. To report suspected abuse, neglect or exploitation of the elderly or a vulnerable adult, please contact the Florida Abuse Hotline at 1-800-96-ABUSE (1-800-962-2873). The Hotline will not be able to confirm receipt of your complaint or respond to any inquiries about action taken on your complaint. WebTo submit a complaint by phone, please call the Medicaid Helpline at 1-877-254-1055 (TDD 1-866-467-4970). Before you ask us for assistance, attempt to solve your issues with the insurer. Depending on the nature, scope, and severity of the complaint allegations, the investigation may take from a few days or weeks, to several months. How you know Like being sent home when youre still in severe pain. WebTo submit a complaint by phone, please call the Medicaid Helpline at 1-877-254-1055 (TDD 1-866-467-4970). 311 W. Washington Street, Suite All plans have a provider complaint system to allow providers to dispute plan policies, procedures, or any aspect of a plans administrative functions, including proposed actions, claims/billing disputes, and service authorizations. OHA.PublicRecords@odhsoha.oregon.gov. NPI is 10 digits long. This toll-free number is available 24/7. For all other requests, contact the Agency's Public Records Office. Provider Manuals/Companion Guides, Enrollment Information/Forms/Training Schedules: Please visit the eMedNY website. The links that are shown are not an exclusive listing of organizations available within the state. TALLAHASSEE, Fla.Attorney General Ashley Moodys Medicaid Fraud Control Unit and the Jacksonville Sheriffs Office today arrested a disabled care provider for Medicaid fraud. External links are made available for the convenience of the internet user. A key drugmaker lobbying group has joined the legal fight against the federal governments plan to negotiate Medicare drug prices. What are the specific allegations (abuse/neglect, acquired infectionsor medication error)?When did this incident occur (date of incident, admission or treatment)?Where is the facility located (name and city)? Media Contact: Laura Hall, 517-290-3779, DIFS-press@michigan.gov Consumer Hotline: 833-ASK-DIFS, AutoInsurance@michigan.gov FOR IMMEDIATE RELEASE: June 28, 2023 (LANSING, MICH) June 28 is National Insurance Awareness Day, and the Michigan Department of Insurance and Financial Services (DIFS) is offering tips WebWhat is your complaint regarding? A complaint number will be assigned and provided at the time of the call. Settings, Start voice Quality of care. Providers now have the ability to save a Complaint Profile, which can be used when submitting a complaint online. Release Date: Jun 23, 2023. Quality of care complaints could include complaints about: Like being given the wrong drug or being given drugs that interact in a negative way. These groups act on behalf of Medicare to address complaints about care provided to people covered by Medicare. Should you choose to file a complaint, know that the Medical Board is required by State law to maintain the confidentiality of all information related to Board investigations. input, Pharmacy Benefit Manager Compliance (PBM), See a list of licensed insurance companies, See what enforcement actions IDOI has taken, File financial information for my insurance company, Enroll for the Municipality Set-Aside Program, File a Patient's Compensation Fund Certificate of Insurance, Residential Real Estate Acquisition of Licensee Information and Numbers "RREAL IN" Database, Report When can I reasonably expect a return phone call? Complaints can be filed by phone, mail, e-mail, or fax. Fraud, waste, or abuse by an HHS employee. HHS-OIGs Hotline reviews and investigates thousands of complaints each year. The more you tell us, the better chance we have of determining whether an investigation can be pursued. For example, you dont think there are enough specialists in the plan to meet your needs. We want to help. But we will thoroughly investigate your problem, advise you whether the company has acted according to the terms of the policy and within the confines of law, and if they have not, will take appropriate action. Mail to: IDOI Attn: Consumer Services Divsion 311 W. Washington Street, Suite 300 Indianapolis, IN 46204-2787. WebTo check the status of a long-term care complaint, contact the Departments Bureau of Long-Term Care at 800-252-4343.For non-long term care complaints contact the You can also file an appeal by phone, fax, mail, email or in person. A Plan of Correction must be approved by the agency before the Statement of Deficiencies may be released. . These reports are called Statements of Deficiencies and the facility or agency must file a Plan of Correction describing how any deficiencies will be remedied. The state of Florida neither endorses links nor approves of links to external sources. ALBANY, N.Y. (June 29, 2023) - The New York State Department of Health today announced it received more than $157 million in federal reimbursement funding to The state of Florida takes no responsibility for a link's operation or content. The provider or the patient can file a complaint with the Department. WebThe Center for Medicaid and CHIP Services (CMCS) is committed to working in close partnership with states, as well as providers, families, and other stakeholders to support You may complete the form online and save or print it.3. You must be a If you need help understanding the language being spoken, Superior has people who can help you on the phone or can go with you to a medical appointment. Attorney General Paxtons Medicaid Fraud Control Unit secured a conviction against Floyd Eugene Dixon, owner of Ambu-Care Transportation, on the charges of first-degree felony theft and health care fraud. STAR+PLUS Medicare-Medicaid Plan (MMP) 1-866-896-1844, Wellcare By Allwell (HMO SNP) 1-877-935-8023. Attn: Consumer Services Divsion. Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment Monitoring System, Clinical Lab Improvement Amendments (CLIA), https://mc.insurance.illinois.gov/messagecenter.nsf, http://illinoisattorneygeneral.gov/consumers/hcform.pdf, https://www.idfpr.com/Admin/Complaints.asp, Long Term Care Incident and Communicable Disease Report, Serious Injury Incident Report Instructions, Grant Accountability and Transparency (GATA), Insurance billing issues should be referred to the Illinois Department of Insurance at, Possible health care fraud should be referred to the Attorney Generals Health Care Fraud Unit at, Licensed personnel issues should be addressed to the Illinois Department of Financial and Professional Regulation at, Mental health issues occurring and DHS-operated facilities can be referred to the Illinois Department of Human Services at, Medicare Billing Problems can be referred to a Medicare Customer Services Representative at. The Department will notify the insurance company of the complaint and ask for their explanation of the problem. Springfield, IL 62761-0001, Health Care Facilities Complaint Form In Texas, Medicaid costs taxpayers over $40 billion. BC/BS of IL - contact Illinois, BC/BS of KY contact Kentucky). The complainant may provide a name, address and phone number to the Department. Staff are available to help you Monday through Friday, Information about injury and violence prevention programs in Michigan. Like not getting treatment after abnormal test results or when you developed a complication. From 2019 to 2021, the dental clinic fraudulently billed Medicaid approximately $6.9 million. Prevention of diseases & conditions such as heart disease, cancer, diabetes and many others. Health Facility Licensing & Certification (HFLC) is responsible for processing complaints for certain types of health care facilities and agencies. Local: 410-786-3000 TTY Toll-Free: 866-226-1819 TTY Local: 410-786-0727 Page Last Modified: 06/14/2023 04:58 PM Help with File Formats and Plug-Ins Where in the facility did the incident occur (room number,unit, or department)?How was the patient harmed? However, we do expect companies to take prompt action on claim, to fully investigate all pertinent facts concerning the claim, and make all insurance settlement offers in good faith. The Medicaid Managed Care plan will review the complaint and notify the person who made the complaint about the decision that is made. All requests for assistance must be in writing and should include: A cover letter describing the problem and how you think the problem should be resolved. WebIf you've called your health or dental plan or the Medicaid helpline and still need help, you can submit your complaint to the Office of the Ombudsman. The MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $20,944,200 for fiscal year (FY) 2023. Most of the time we can help you right away. Information on Safe Sleep for your baby, how to protect your baby's life. Insurers have 20 business days from receiving the complaint to respond. Fax form to: 217-524-8885, Health Care Facilities Complaint Form If there is additional information to be provided, you may call back and add it to the initial complaint. The Appeals button is at the top of every screen. TheState Survey Agency is usually part of yourState department of health services. The Michigan Department of Health and Human Services' (MDHHS) Division of Environmental Health (DEH) uses the best available science to reduce, eliminate, or prevent harm from environmental, chemical, and physical hazards. You should wait at least six months before filing such a request. Please note: if the claim involves Workers Compensation, direct your complaint to the Workers Compensation Board, 402 W. Washington St. Rm. Example of problems to ask our assistance on: non-payment or continuous late payment of claims, down-coding of claims without notice, payment of non-network provider fee instead of usual and customary. If you suspect Medicaid fraud or abuse, or patient neglect, please report it by visiting the OAGs website. OIG rarely intervenes in personal or civil grievances. Report it to Social Security Administration OIG, SNAP/Food Stamp Fraud. If the issue involves a Medicaid Managed Care Plan, you should use the plans provider complaint process prior to submitting a complaint to the Agency. Not all companies are licensed in Indiana; complaints should be directed to the Department of Insurance in the state where the company is licensed and the policy sold (i.e. For reporting abuse, neglect, or exploitation of children, the elderly or people with disabilities, please visit the Texas Abuse Hotline or call 1-800-252-5400. Illinois Legal Aid Online (ILAO) through their online form, Health Benefits for Immigrants 65 Years or Older, Health Benefits for Immigrants Ages 42-64, Call the free CARPLS Legal Aid Hotline at 312-738-9200. Information on communicable & chronic diseases. WebWe would like to show you a description here but the site wont allow us. Claims Payment THE DEPARTMENT CANNOT ACT AS YOUR COLLECTION SERVICE. Universal caseload, or task-based processing, is a different way of handling public assistance cases. 7500 Security Boulevard, Baltimore, MD 21244, Filing complaints about a doctor, hospital, or provider, Filing complaints about your health or drug plan, Filing a complaint about durable medical equipment (DME), Authorization to Disclose Personal Health Information (PDF), Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), Find out how to file a complaint about your dialysis or kidney care, Find a Medicare Supplement Insurance (Medigap) policy. Request Network Participation, Non-Contracted Providers Only, Add a Provider to an Existing Group Contract, Add a Practice Location to an Existing Contract, Practice Improvement Resource Center (PIRC), Updating Provider Demographic Information, Effective 1/1: Electronic Prescribing of Controlled Substances Required, Effective September 1, 2021: Benefit Changes to Total Disc Arthroplasty for Medicaid and CHIP, Effective July 15, 2021 through December 31, 2021: Temporary Relaxation of Prior Authorization Requirements for DME, Orthotic, and Enteral/Parenteral Nutrition and Medical Supplies, Javelina legend and NFL hall of famer Darrell Green gives back to Kingsville, Superior HealthPlan, Pro Football Hall of Famer Darrell Green Help Make First Back-to-School Community Fair & Fest in Kingsville a Success, Provider Notice of Adverse Benefit Determinations, Superior to Override Timely Filing for Claims Impacted by Texas Medicaid Healthcare Partnerships (TMHP) Eligibility Verification Issues, https://www.tdi.texas.gov/consumer/get-help-with-an-insurance-complaint.html. WebYou must file a Notice of Appeal within 60 days of the date of the denial notice. If you dont believe your complaint has been resolved, call yourstate home health hotline. Visit SMMCfor more information. Please submit any relevant documentation to the complaint: Items in the trash will be permanently removed after 30 days. Medical identity theft involving Medicare and/or Medicaid beneficiaries. Kickbacks or inducements for referrals by Medicare or Medicaid providers. They can help resolve Official websites use .gov Or CHIP members can send a letter to: Texas Department of Insurance You must be a resident of the state where you are applying for benefits. Staff are available to assist you Monday through Friday, 8am You or your Designated Personal Representative (DPR) can make the call. OIG Hotline Operations is not a statutory entity, court, or other administrative body. Please note: Some documents may be too large to send through the Online Complaint Form. Typically for an individual policy you would contact the state of residence of employer/group. mail, e-mail orfax. Birth, Death, Marriage and Divorce Records. A key drugmaker lobbying group has joined the legal fight against the federal governments plan to negotiate Medicare drug prices. WebOffice of the Medicaid Inspector General: For suspected fraud, waste or abuse complaints/allegations, call 1-877-87FRAUD, (877) 873-7283, or visit Office of Medicaid Inspector General (OMIG) web site. You may complete the form online and save or print it. Please fill out our online complaint form below and we will get in touch with you shortly. If you have questions about public records requests, contact A variety of reports & statistics for programs and services. Entities Covered by Authorization: Physician or medical practitioner; hospital or health clinic or facility; insurance company; The Appeals button is at the top of every screen. If you believe an entity is not complying with the Federal Independent Dispute Resolution process, or you want to report a violation of the protections of the No Surprises Act, then you may contact the No Surprises Help Desk at 1-800-985-3059 to submit a question or complaint. WebTo file your complaint, call (888) 419-3456, or complete the Health Care Facility Complaint Form . Office of Health Care Regulation Issues about Medicare policy, coverage, billing claims or appeals, Lost or stolen Medicare card. Is denying coverage for care you think should be covered. The appeal can be filed at your local DHS office, in the following ways: Your local Family Community If you have received an assigned complaint number, pleaseprovide it when you contact our office. WebThere is no time limit for filing a complaint with Superior. If it is determined that the concerns fall under the jurisdiction of another agency or organization the letter will provide you with that information. Download the Health Care Facility/Agency Complaint IntakeForm.2. mailbox.hclc@odhsoha.oregon.govFAX:(971) 673-0556. You can file it with the plan over the phone or in writing. Information on the Food Assistance Program, eligibility requirements, and other food resources. To file a complaint about conditions at a hospital (like rooms being too hot or cold, cold food, or poor housekeeping) contact yourState department of health services. Find out how to file a complaint about your dialysis or kidney care. The IG Act gives the Inspector General sole discretion regarding the processing and investigation of hotline complaints. Information on the Children's Foster Care program and becoming a Foster Parent. To file a complaint about your doctor (like unprofessional conduct, incompetent practice, or licensing questions),contact your State medical board. We accept complaints about fraud, waste and abuse in Medicare, Medicaid and other HHS LANSING Valda Cork, 60, pled guilty in Saginaw Circuit Court to one count of Embezzlement of $100,000 or more from a Vulnerable Adult, Failure of a hospital to evaluate and stabilize an emergency patient, Abuse or neglect in nursing homes and other long-term-care facilities, Human Trafficking by HHS employees, contractors or grantees to include procuring a commercial sex act. If you are not able to attach due to size, please send using one of the other options listed above. Use theMedicare Complaint Formor follow the instructions in your plan membership materials to submit a complaint about your Medicare health or prescription drug plan. ems.psu@dhsoha.state.or.usFAX:(971) 673-0555. Your browser is out-of-date! WebThe Colorado Attorney General wants to hear from you. This field is required. If you are a provider who is contracted to provide care and services to our Blue Cross Community Facilities and Agencies Regulated by HFLC. The defendants are also accused of offering illegal kickbacks to marketers and caregivers of Medicaid-insured children, enticing them to bring the children to Floss for fraudulent dental services. The indictment also details how Gaviola laundered Medicaid funds, transferring them from the Floss business bank account to his personal account in transactions exceeding $100,000. Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. The state of Florida neither endorses links nor approves of links to external sources. Or, a Superior Member Services Advocate can help you file an appeal. Remember: Superior has staff that speaks English and Spanish. Consumers may file a formal complaint by visiting Michigan.gov/DIFScomplaints. Complaints may be filed by, but are not limited to, patients, patient family members, care givers, staff or advocacy groups. The Pharmaceutical Research WebFiling a complaint about your quality of care Contact your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for complaints about the quality of OIG Hotline Operations complaints are official records covered by the Privacy Act. To make inquiries, you must have the name and location of the facility. We want you to tell us about your complaint. Superior does not accept responsibility or liability for any loss or damage arising from the use of email. How you file a complaint depends on what An official website of the Florida State government. To submit a complaint by phone, please call the Medicaid Helpline at 1-877-254-1055 (TDD 1-866-467-4970). Medicaid ID # (a letter and 6 #s on your card) Address and phone number. This process can be extended up to fourteen (14) days if you ask for an extension.

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