Fraud and Compliance | Healthfirst

Fraud & Compliance

Healthfirst has a zero-tolerance policy toward fraud and abuse. Help us maintain our commitment to ethical practice by reporting fraud when you see it.

Fraud

To report Medicare fraud, you may contact:

connection image

The Office of Inspector General

connection image

The Centers for Medicare & Medicaid Services (CMS)

connection image

The Centers for Medicare & Medicaid Services (CMS)

  • Attention: Mail Beneficiary Contact Center,
  • P.O. Box 39
  • Lawrence, KS, 66044.

To report Medicaid fraud, you may contact:

connection image

The New York State Office of the Medicaid Inspector General (OMIG)

Compliance

Our commitment to compliance is supported by our confidential compliance hotline and website, which are completely anonymous and accessible 24 hours a day, 7 days a week, 365 days a year. We encourage employees, members, FDRs (First Tier, Downstream, and Related Entities), providers, and vendors to report suspected cases of fraud, waste, abuse, or other violations of company policy in whatever manner they feel most comfortable. We have also established company-wide policies to promote a compliant workplace, such as non-retaliation, internal investigation, self-reporting, and more. For more information, please read our Code of Conduct.

If you suspect a case of fraud, waste, abuse, or other violations of company policy, you can report it by:

connection image

Calling our toll-free Confidential Compliance Hotline:

1-877-879-9137

connection image

Filing a report via the Confidential Website

File a Report

Healthfirst’s commitment to compliance includes ensuring that our First Tier, Downstream, and Related Entities (FDRs) and Affiliates are in compliance with applicable state and federal regulations. Healthfirst contracts with FDRs and Affiliates to provide administrative or healthcare services to our enrollees; we are ultimately responsible for fulfilling the terms and conditions of our contract with the Center for Medicare & Medicaid Services (CMS) and meeting the Medicare and Medicaid program requirements. Therefore, Healthfirst has developed a process to validate that each contracted entity has met the requirements.

Every FDR and Affiliate (including hospital systems, providers, and vendors) must complete an electronic FDR and Affiliate Compliance Attestation annually.

Please visit our website at HealthfirstFDR.org to review the FDR and Affiliate Compliance Guide, which includes the FDR and Affiliate compliance requirements, and to complete the FDR and Affiliate Compliance Attestation.

Support when you need it

Contact Us
Close Popup