Fraud & Abuse FAQ

Q: My primary care physician (PCP) is misusing my benefits. What should I do?
A: Report it immediately to our Customer Service Department at 616 942-4765 or 800 942-4765.  Our hours are:

• Monday through Thursday 7:30 a.m. to 7:00 p.m.
• Friday 9:00 a.m. to 5:00 p.m.
• Saturdays 8:30 a.m. to 12:00 p.m.

You may also submit a complaint or tip online by clicking fraud and abuse. Be prepared to give the provider's name, provider's address, nature of your complaint, date of service, and amount billed for the service(s). You don't have to give us your name.

Q: I think someone is sharing his/her ID card. What should I do?
A: Report it immediately to our Customer Service Department (see above).

Q: Is it possible to receive a status report for my fraud and abuse complaint/tip?
A: No. Federal regulations require that we do not give out status reports or any information about how we are handling a complaint to anyone, not even the person who made the complaint. Please know that the information you provide to us will be taken seriously and we will take action on it according to our guidelines and legal requirements.

Q: Is there a reward for information I supply that identifies fraud and abuse?
A: No, there are no rewards for fraud and abuse information.