Fraud and Abuse

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's 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.

Medica Provider Administrative Manual

Fraud and Abuse: Medica’s position on and investigation of fraud and abuse, Medica’s Special Investigations Unit (SIU), and financial and health record-keeping requirements. 

CMS Requirements for Fraud, Waste, and Abuse Compliance Training: This training requirement applies to all organizations that provide health care services or administrative services for Medicare-eligible individuals under the Medicare Advantage or Medicare Part D programs. 

Points of Contact

To report suspected fraud or abuse committed against Medica, call Medica's Special Investigations Unit at 952-992-8478 or 1-800-458-5512 (option 1, option 8, ext. 2-8478), during business hours. At other times, please call Medica's fraud Hotline.

For English and Spanish call 952-992-2237 or 1-866-821-1331. For Russian 952-992-3893; for Somali 952-992-3214.

View Medica's policy on reporting of suspected false claims.

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.

Download General Instructions for Investigative Inquiry Form.
Download Investigative Inquiry Form.



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