Preventing Fraud, Waste and Abuse

As part of our efforts to improve the healthcare system, America's 1st Choice has made a commitment to detecting and preventing fraud, waste, and abuse.

Success in this effort is essential to maintaining a healthcare system that is affordable for everyone. America's 1st Choice is getting the word out about how physicians and other health care providers can help with fraud, waste and abuse prevention.

What is Fraud, Waste, and Abuse?

Fraud is generally defined as making a false claim in an effort to receive payment. For example, fraud in the healthcare industry can involve:

  • Billing for medical services that weren't ordered or provided
  • Billing for durable medical equipment items that weren't ordered or provided
  • Providing services or items a person doesn't need based on his or her medical history
  • "Doctor shopping" – when a patient who may or may not have a legitimate physical ailment goes from doctor to doctor to obtain multiple prescriptions for narcotic painkillers

To protect yourself from fraud, thoroughly review your Explanation of Benefits (EOB) after you receive healthcare services. If you see something that doesn't look right, you should report the situation right away.

How to Report Fraud, Waste, and Abuse

To report suspected fraud, waste, or abuse, you can contact America's 1st Choice in one of these ways:

Any individual, entity, or group that is employed by or provides a service on behalf of America’s 1st Choice Health Plans, Inc. (including employees, subscribers, professional providers, employees of a provider, facilities, or billing companies) may be the subject of the complaint.

You will receive a response to your complaint, unless you choose to remain anonymous.

Last Updated: 09/23/2015