Fraud, Waste & Abuse 

Neighborhood has an obligation and is committed to reporting cases of fraud 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 and abuse. These are situations you think may not be right.

Fraud happens when a member or provider does something that is not honest so that he/she or another person experiences positive results or some type of benefit or incentive. 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 and abuse:

  • 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 the Compliance Officer at 1-401-427-6799 or the Compliance Hotline at 1-888-579-1551.

Helpful Links

  • Fraud and Abuse (Please note: By clicking on this link, you will be leaving the Neighborhood Health Plan of Rhode Island INTEGRITY website.)
  • Privacy and Security of Member Information  (Please note: By clicking on this link, you will be leaving the Neighborhood Health Plan of Rhode Island INTEGRITY website.)
  • Notice of Privacy Practices  (Please note: By clicking on this link, you will be leaving the Neighborhood Health Plan of Rhode Island INTEGRITY website.)
  • Compliance Contacts  (Please note: By clicking on this link, you will be leaving the Neighborhood Health Plan of Rhode Island INTEGRITY website.)

Have questions?

Please call us at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free. 

Neighborhood Health Plan of Rhode Island is a health plan that contracts with both Medicare and Rhode Island Medicaid to provide the benefits of both programs to enrollees.

This information is available for free in other languages. Please call our Member Services at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

Esta información está disponible de forma gratuita en otros idiomas. Por favor llame a nuestro Departamento de Servicios para Miembros al 1-844-812-6896 (TTY 711) de 8 am a 8 pm, lunes-viernes; sábados de 8 am a 12 pm. Los sábados por la tarde, domingos y días festivos federales, se le pedirá que deje un mensaje. Su llamada será devuelta dentro del siguiente día laborable. La llamada es gratuita.

Estas informações estão disponíveis gratuitamente noutros idiomas. Por favor telefone para os Serviços dos Membros em 1-844-812-6896 (TTY 711), das 8 às 20 horas, de Segunda a Sexta-feira; e das 8 às 12 (meio-dia) aos Sábados. Nos Sábados à tarde, Domingos e feriados federais, poderá ser-lhe pedido que deixe uma mensagem. A sua chamada será respondida no próximo dia útil. Esta chamada é grátis.

Our plan can also give you materials in Spanish and Portuguese and 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.

Last Updated January 9, 2017, 3:59 pm

H9576_ WebFWA CMS Approved 9/13/16