Providers

Champion Health Plan
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.

Regulatory Requirement
In accordance with 42 CFR §§ 422.503(b)(4)(vi) and 423.504(b)(4)(vi), Champion Health Plan maintains effective lines of communication that allow reporting of suspected or actual noncompliance and FWA. These reporting mechanisms support confidential and anonymous reporting and enforce a non-retaliation policy.

Definitions
Fraud
Knowingly and willfully executing or attempting to execute a scheme to defraud any healthcare benefit program or to obtain payment through false representations.
Waste
The over-utilization of services or other practices that directly or indirectly result in unnecessary costs to the Medicare program.
Abuse
Practices that are inconsistent with accepted medical, business, or fiscal practices and that result in unnecessary costs or improper payment, but are not intentional fraud.

Examples of FWA
Examples of FWA include, but are not limited to:

Billing for services not rendered
Upcoding or unbundling services
Submitting claims for medically unnecessary services
Altering or falsifying medical records
Duplicate billing
Kickbacks or inducements
Misrepresentation of diagnosis or procedure codes
Inappropriate prescribing or dispensing of medications

Providers and FDRs are expected to report suspected, potential, or actual FWA and compliance issues.

How to Report FWA or Compliance Concerns
Reports may be made confidentially or anonymously using any of the methods below.
Compliance & FWA Hotline (Toll-Free):
📞 1-800-714-5090
📞 TTY: 711
Email:
✉️ Hotline@championpayer.com
Fax:
📠 Fax Number: 949-998-9856

When submitting a report, please include relevant details, such as names, dates, services involved, claim numbers, and a description of the concern. You are not required to identify yourself.

Confidentiality & Non-Retaliation
Champion Health Plan:

Maintains confidentiality to the extent permitted by law
Allows anonymous reporting
Prohibits retaliation against any individual who reports a concern in good faith, regardless of the outcome

Retaliation against individuals who report suspected FWA or compliance issues is strictly prohibited and may result in disciplinary action, up to and including termination of contract.

Reporting to Government Agencies
Providers and FDRs may also report suspected Medicare fraud directly to federal authorities:

HHS Office of Inspector General (OIG)
📞 1-800-HHS-TIPS (1-800-447-8477)
🌐 https://oig.hhs.gov/fraud/report-fraud/
Medicare
📞 1-800-MEDICARE (1-800-633-4227)
🌐 https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse

Reporting concerns to Champion Health Plan does not limit your right or obligation to report directly to CMS or OIG.

Provider & FDR Responsibilities
As a provider or FDR, you are required to:

Comply with all applicable Medicare laws, regulations, and CMS guidance
Maintain policies and procedures that address FWA prevention and detection
Complete required CMS FWA and Compliance training
Report suspected or actual FWA and compliance issues promptly

Failure to report known or suspected FWA may result in corrective action or referral to CMS or law enforcement.

Champion Health Plan Commitment
Champion Health Plan investigates all reported concerns promptly and thoroughly and takes appropriate corrective action when necessary. Our compliance program is designed to ensure ongoing compliance with CMS requirements and protect the integrity of the Medicare program.