Fraud, Waste, and Abuse Compliance

EGID is committed to conducting its business activities with integrity and in full compliance with the federal, state and local laws governing its business. This commitment applies to relationships with members, providers, auditors and all public and government bodies. Most importantly, it applies to employees, subcontractors and representatives of EGID. This commitment includes the policy that all such individuals have an obligation to report problems or concerns involving ethical or compliance violations related to its business.

If you suspect that EGID and/or Medicare have been defrauded, are being defrauded or that resources have been wasted or abused, report the matter to the EGID Compliance Officer immediately. You can report suspicious acts or claims by:

• visiting the Compliance Officer in person
• sending a report in writing to:

OSEEGIB Compliance Officer
3545 NW 58 Street, Ste 110
Oklahoma City, OK 73112

• emailing a message to antifraud@sib.ok.gov
• leaving a report in the secure drop box outside the EGID Board Room Floor 5
• calling the EGID toll-free hotline at 1-866-381-3815

Access the Compliance Plan and the Standards of Conduct.

Individuals are encouraged to provide adequate information in order to assist with further investigation of fraud. All investigations will be handled confidentially. Every attempt will be made to ensure the confidentiality of any report, but please remember that confidentiality may not be guaranteed if law enforcement becomes involved. There will be no retaliation against anyone who reports conduct that a reasonable person acting in good faith would have believed to be fraudulent or abusive. Any employee who violates the non-retaliation policy will be subject to disciplinary action up to and including termination.

In addition, the Centers for Medicare and Medicaid Services (CMS) has contracted with Health Integrity, LLC to be a Medicare Prescription Drug Integrity Contractor (MEDIC). Health Integrity, LLC has been authorized by CMS to monitor the new prescription drug program and to investigate any beneficiary complaints related to the Medicare prescription drug benefit.

Health Integrity, LLC is interested in receiving reports of potential fraud, waste or abuse from Medicare beneficiaries. Examples of these types of complaints may include:

• An individual or organization pretends to represent Medicare and/or Social Security, and asks you for your Medicare or Social Security number, bank account number, credit card number, money, etc.
• Someone asked you to sell your Medicare prescription drug card.
• Someone asked you to get drugs for them using your Medicare prescription drug card.
• You were encouraged to disenroll from your plan.
• You were offered cash to sign up for a Medicare prescription drug plan.
• You were offered a gift worth more than $15 to sign up for a Medicare prescription drug plan.
• Your pharmacy did not give you all of your drugs.
• You were billed for drugs that you didn’t receive.
• You believe that you have been charged more than once for your premium costs.
• Your Medicare prescription drug plan did not pay for your covered drugs.
• You received a different drug than your doctor ordered.

You may contact EGID at 1-866-381-3815 or Health Integrity, LLC at 1-877-7SafeRx -1-877-772-3379 to report complaints about one of these types of fraud, waste, and abuse issues or a related complaint. Health Integrity, LLC’s fax number is 1-410-819-8698 and its website is healthintegrity.org.

If you have a general question or concern related to your Medicare drug benefit and it is not a potential fraud, waste or abuse issue, please contact HealthChoice at 1-405-717-8780 or toll-free 1-800-752-9475. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.