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Fraud and Abuse

Help prevent fraud, waste and abuse

Members can help Gateway Health uncover provider fraud, waste, and abuse. You should keep track of the following things:

• Who provided your health care

• What services you received during the visit and any additional tests or visits the doctor ordered

• When you got a health care service

• Where the service took place

Call Gateway Health if you think the provider may have billed wrong or offered a service you didn’t think you needed. Please remember, DO NOT:

• Give your ID card or numbers to anyone other than your doctor, clinic, hospital or other health care provider

• Ask your doctor or any other health care provider for medical services or supplies that you don’t need

• Sign your name to a blank form

• Share your medical records with anyone other than your doctor, clinic, hospital or other health care professional

• Gateway has a team that works hard to identify and prevent fraud, waste, and abuse. But we still need all providers and members to report possible fraud and abuse.

To Report Fraud or Abuse

By Mail:

Special Investigations Unit
444 Liberty Avenue Suite 2100
Pittsburgh, Pa 15222

DPW Bureau of Program Integrity Managed Care Unit
P.O Box 2675
Harrisburg, PA 17105-2675

412-255-4340 or 800-685-5235. You have the option to remain anonymous at all times.