Neighborhood has an obligation and is committed to preventing, detecting and correcting incidents of fraud, waste and abuse. To protect the availability of health care services, we work to ensure the appropriate use of money for the Neighborhood INTEGRITY program. We want you to report suspected cases of fraud, waste and abuse. These are situations you think may not be right.
Fraud happens when a member or provider intentionally does something that is not honest so that he/she or another person experiences positive results or some type of benefit or incentive. Waste happens when there is an overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the health care system. Abuse happens when appropriate business and medical practices are not followed, and the result is an unnecessary cost to the Neighborhood INTEGRITY program.
Below are some examples of fraud, waste and abuse:
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- Sharing, loaning, changing, or selling a Neighborhood INTEGRITY ID card so someone else can get health care services.
- Using someone else’s Neighborhood INTEGRITY ID card to get health care services.
- Using a provider’s prescription pad. Altering or forging a provider’s prescription to receive drugs.
- Having Rhode Island Medicaid and another state’s Medicaid at the same time.
- Lying about how much money you make or where you live to become eligible for benefits.
- Lying about services received under self-directed care.
- Selling or giving prescriptions to others that were prescribed to you.
- Providers or hospitals that bill you or Neighborhood for services that were never provided.
If you suspect fraud, waste, or abuse, please call Neighborhood’s anonymous Compliance Hotline at 1-888-579-1551.
Helpful Links
Questions?
Please call us at 1-844-812-6896 (TTY 711), 8 a.m. to 8 p.m., Monday – Friday; 8 a.m. to 12 p.m. on Saturday. On Saturday afternoons, Sundays, and holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.
Neighborhood INTEGRITY (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Rhode Island Medicaid to provide the benefits of both programs to enrollees.
Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intérprete, por favor llame al 1-844-812-6896 (TTY 711). Alguien que hable español le podrá ayudar. Este es un servicio gratuito.
Dispomos de serviços de interpretação gratuitos para responder a qualquer questão que tenha acerca do nosso plano de saúde ou de medicação. Para obter um intérprete, contacte-nos através do número 1-844-812-6896 (TTY 711). Irá encontrar alguém que fale o idioma Português para o ajudar. Este serviço é gratuito.
យើងមានសេវាអ្នកបកប្រែផ្ទាល់មាត់ដើម្បីឆ្លើយរាល់សំណួរដែលអ្នកអាចមានអំពីគម្រោងសុខភាព និងថ្នាំរបស់យើងខ្ញុំ។ ដើម្បីទទួលបានអ្នកបកប្រែផ្ទាល់មាត់ គ្រាន់តែហៅទូរសព្ទមកយើងខ្ញុំតាមរយៈលេខ 1-844-812-6896 (TTY 711)។ អ្នកដែលនិយាយខ្មែរជួយអ្នកបាន។ នេះជាសេវាកម្មឥតគិតថ្លៃ។
Our plan can also give you materials in Spanish, Portuguese, and Khmer in formats such as large print, braille, or audio. Call Neighborhood INTEGRITY Member Services to make a standing request to receive your materials now and in the future, in your requested language or alternate format. Call Neighborhood INTEGRITY Member Services to make a standing request to receive your materials now and in the future, in your requested language or alternate format.
Last updated: November 12, 2024 @ 3:23 pm
H9576_ WebFWA25_Approved 10/23/24