Champion Health Plan is committed to preventing, detecting, and correcting Fraud, Waste, and Abuse (FWA) in the Medicare program. As a contracted provider, supplier, or First Tier, Downstream, or Related Entity (FDR), you play a critical role in identifying and reporting potential FWA and compliance concerns.
Champion Health Plan maintains a comprehensive compliance program that meets the requirements of CMS Medicare Advantage (Part C) and Prescription Drug (Part D) regulations.
Fraud: Knowingly and willfully executing a scheme to obtain money or benefits through false representations.
Waste: Overuse or misuse of services that result in unnecessary costs.
Abuse: Practices that may lead to unnecessary costs or improper payment but are not intentional fraud.
Examples include billing for services not provided, falsifying medical records, offering or accepting kickbacks, or misuse of member identification numbers.
You may report suspected Fraud, Waste, or Abuse using any of the methods below. Reports may be made anonymously.
Phone (Toll-Free Hotline): 1-800-714-5090 | TTY: 711
Email: Hotline@championpayer.com
Fax: 949-998-9856
You may provide as much or as little information as you are comfortable sharing. Helpful details include names, dates, services involved, and a description of the concern.
Champion Health Plan maintains the confidentiality of all reports to the extent permitted by law.
We strictly prohibit retaliation against any individual who reports a concern in good faith, even if the investigation determines no violation occurred.
You may also report suspected Medicare fraud directly to federal agencies:
1-800-HHS-TIPS (1-800-447-8477)
https://oig.hhs.gov/fraud/report-fraud/
1-800-MEDICARE (1-800-633-4227)
https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse
Our Commitment
Champion Health Plan maintains a comprehensive compliance program in accordance with CMS Medicare Advantage requirements. Reporting suspected Fraud, Waste, or Abuse helps protect our members, the Medicare program, and the integrity of the healthcare system.
If you have questions about this process or Champion Health Plan’s compliance program, please contact us using the information above.
