ANTI-FRAUD | ADVANTAGE Preferred Plus

Anti-Fraud

Our Commitment Against Fraud & Corruption

ADVANTAGE is committed to the fight against fraud and corruption. ADVANTAGE employees, management, and Directors refrain from conduct that may violate the fraud and abuse laws. The laws prohibit:

direct, indirect or disguised payments in exchange for the referral of patients;

the submission of false, fraudulent or misleading claims to any government entity or third party payor, including claims for services not rendered, claims which characterize the service differently than the service actually rendered, or claims which do not otherwise comply with applicable program or contractual requirements; and

making false representations to any person or entity in order to gain or retain participation in a program or to obtain payment for any service.

Employees, members, providers and contractors can provide valuable information to alert ADVANTAGE to possible fraud and abuse issues. Therefore, ADVANTAGE has established reporting mechanisms to ensure timely identification and resolution of issues or suspicions of fraud. We have contracted with FPV, Inc. to establish and manage an external help line. T he help line will allow employees, members, providers, and contractors to report suspicion of fraud anonymously or in confidence and without fear of retaliation. Individuals who report problems and concerns in good faith via the help line will be protected from any form of retaliation. All those who are employed in the external help line operation are expected to act with utmost discretion and integrity in assuring that information received is acted upon in a reasonable and proper manner. Each FPV employee involved with the ADVANTAGE help line will be required to sign a confidentiality agreement.

You may call the ADVANTAGE Help Line at 1-888-333-9576. Our current call center hours are Monday - Friday from 8am - 9pm, and Saturday from 8am - 6pm

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Anti-Fraud

Our Commitment Against Fraud & Corruption ADVANTAGE is committed to the fight against fraud and corruption. ADVANTAGE employees, management, and Directors refrain from conduct that may violate the fraud and abuse laws. The laws prohibit: direct, indirect or disguised payments in exchange for the referral of patients; the submission of false, fraudulent or misleading claims to any government entity or third party payor, including claims for services not rendered, claims which characterize the service differently than the service actually rendered, or claims which do not otherwise comply with applicable program or contractual requirements; and making false representations to any person or entity in order to gain or retain participation in a program or to obtain payment for any service. Employees, members, providers and contractors can provide valuable information to alert ADVANTAGE to possible fraud and abuse issues. Therefore, ADVANTAGE has established reporting mechanisms to ensure timely identification and resolution of issues or suspicions of fraud. We have contracted with FPV, Inc. to establish and manage an external help line. T he help line will allow employees, members, providers, and contractors to report suspicion of fraud anonymously or in confidence and without fear of retaliation. Individuals who report problems and concerns in good faith via the help line will be protected from any form of retaliation. All those who are employed in the external help line operation are expected to act with utmost discretion and integrity in assuring that information received is acted upon in a reasonable and proper manner. Each FPV employee involved with the ADVANTAGE help line will be required to sign a confidentiality agreement. You may call the ADVANTAGE Help Line at 1-888-333-9576. Our current call center hours are Monday - Friday from 8am - 9pm, and Saturday from 8am - 6pm