Fraud and Abuse
Call the Fraud Tipline at 1-844-DHS-TIPS or report provider and/or recipient fraud with the online form.
Unfortunately, a small number of Medical Assistance recipients and providers engage in practices that are fraudulent or abuse of the Medical Assistance program. To report suspected fraud or abuse of services provided under the MA Program, please call the Bureau of Program Integrity at 1-844-DHS-TIPS (1-844-347-8477), Send reports online with the Hotline Response Form, or write to us at:
Department of Human Services, Office of Administration
Bureau of Program Integrity
P.O. Box 2675
Harrisburg, PA 17105-2675
Suspect it? Report it! Call ChildLine at 1-800-932-0313. Mandated reporters can report electronically.
Elder Abuse or Abuse of an Adult with a Disability
Suspect abuse of an elder or an adult with a disability? Report it by calling 1-800-490-8505. Get forms and more information from Adult Protective Services.
The Office of Administration's Bureau of Program Integrity (BPI) requires that all employees maintain strict confidentiality concerning the facts of the cases to which they are assigned. No information obtained in the course of conducting reviews may be used for purposes other than the official administration of the Medical Assistance (MA) Program. The overall guiding principle is to provide for the minimum necessary use and disclosure of protected health information required to accomplish the objectives of BPI.
Medical records and claims information are used to determine the necessity, quality and appropriateness of services billed, the accuracy of the coding/billing, resolution of patient complaints, recipient restriction, and for evaluation of the MA Program.
Information may be provided for purposes of treatment, payment, and health care operations. Assisting in investigations, prosecutions, and civil or criminal proceedings related to the administration of the MA Program are all considered health care operations for which necessary disclosure is appropriate. The medical assistance application signed by recipients includes an authorization for release of personal, financial, and medical information for the purpose of determining eligibility and for review of the MA Program.
BPI closely monitors disclosures of personal health information. Any information shared by BPI with other government agencies/medical professionals/contracted associates must be subject to the same applicable rules and regulations regarding protected health information.