Medica's Special Investigations Unit (SIU)
Medica’s Special Investigations Unit (SIU) investigates allegations of fraud and abuse committed against Medica. The SIU's mission is to prevent, identify, investigate, report and, when appropriate, recover money from health care fraud and abuse. These actions help ensure that member premium dollars are spent for legitimate health care purposes. The SIU is authorized to conduct post-payment reviews to ensure compliance with Medica requirements. To accomplish this, the SIU monitors use of health services by members and the delivery of health services by Medica participating providers.
Examples of fraud include:
- Billing for a medical service or equipment that was not provided.
- Using another person’s ID card to obtain medical services.
Learn more about Medica's investigation of fraud, waste and abuse; the Medica SIU; and financial and health record-keeping requirements.
Compliance Awareness and Fraud, Waste and Abuse Awareness Training
for Medica Providers
This training requirement applies to all organizations and their downstream entities that provide health care services or administrative services for Medicare-eligible individuals under the Medicare Advantage or Medicare Part D programs.
The requirement affects you as an entity that provides administrative or health care services for Medicare members and your downstream related entities. As a result of the Centers for Medicare and Medicaid Services (CMS) requirement, all of your organizations, and downstream related entities, employees and board members will need to complete Medica’s compliance awareness and fraud waste and abuse awareness training or a similar training that meets the CMS requirements upon contract and annually thereafter.
Providers that are Medicare Certified are exempt from taking the fraud, waste and abuse training, however, providers are still required to complete Medica's compliance awareness training, or complete a comparable training that meets CMS requirements. As part of completing the general compliance training, you must also review, and agree to comply with, Medica's Standards of Conduct and Reporting Policy or comparable standards of conduct and policies of your own that meet CMS requirements.
Your organization should keep a copy of all documentation related to this training requirement for the required record retention period of 10 years.
If you have any questions or concerns regarding this requirement, you may call the Medica Provider Service Center toll-free at 1-800-458-5512.
Standards of Conduct
Points of Contact
To report suspected fraud or abuse committed against Medica, call the Medica Special Investigations Unit at 952-992-8478 or 1-800-458-5512 (option 1, option 8, ext. 2-8478), during business hours. You can also call Medica’s fraud hotline, available 24 hours day, 7 days a week at 1-866-821-1331.
To report Medicare related incidents, call the Medica Medicare Compliance department at 952-992-3400 or 1-888-906-0972.
To remain anonymous, call the Medica Integrity Line at 1-866-595-8495.
For English and Spanish call 952-992-2237 or 1-866-821-1331. For Russian 952-992-3893; for Somali 952-992-3214.
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You may also print the Investigative Inquiry Form below. Fill out the form and fax to the SIU Department at 952-992-3117. Follow the General Instructions for Investigative Inquiry Form.