Clinical Practice Guidelines

Each guideline addresses a specific condition, diagnosis, therapeutic intervention, and patient education and referrals. Guidelines are available for ADHD, Alcoholism, Depression, Pain Management and many other topics. For copies, go to priorityhealth.com or call the Behavioral Health department.

Fraud and Abuse Awareness
Do you have a patient who you believe may be sharing their ID card with someone else? This is an example of fraud and abuse. A member of your office staff should report all suspected fraud or abuse to Priority Health.

Examples of fraud and abuse:

• a member shares his/her Priority Health ID card
• a member and/or provider overstates the member’s illness
• a member forging or selling prescriptions
• a provider bills for services not provided
• a provider receives payments for making patient referrals

How to Report Suspicious Activity
If you suspect someone of fraud or abuse please contact Priority Health immediately. You are not required to give your name. You may contact us by:

• Calling the Provider Helpline at 616 942-4765 or 800 942-4765 Monday through Thursday 7:30 a.m. to 7 p.m., Friday 9 a.m. to 5 p.m., and Saturdays 8:30 a.m. to noon.
• Calling the Compliance hotline at 800 560-7013, 24 hours a day.
• Write us at Priority Health, Fraud and Abuse Program - MS 2305 1231 East Beltline NE, Grand Rapids, MI 49525-4501

If you suspect a Medicaid fraud, contact the State Medicaid Department directly by:

• Calling toll-free 866 428-0005
• Going online at michigan.gov/mdch.
• Sending a letter to Program Investigation Section Capitol Commons Center Building 400 South Pine, 6th Floor Lansing, Michigan 48909