Fraud, Waste & Abuse

Neighborhood has an obligation and is committed to preventing, detecting and correcting incidents of fraud, waste 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, waste and abuse. These are situations you think may not be right.

Fraud happens when a member or provider intentionally does something that is not honest so that he/she or another person experiences positive results or some type of benefit or incentive. Waste happens when there is an overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the health care system. 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, waste 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 Neighborhood’s anonymous Compliance Hotline at 1-888-579-1551.

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Please call us at 1-844-812-6896 (TTY 711), 8 a.m. to 8 p.m., Monday – Friday. 8 a.m. to 8 p.m., 8 a.m. to 12 p.m. on Saturday. On Saturday afternoons, Sundays, and 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.

Last updated: October 25, 2023 @ 5:03 pm

H9576_ WebFWA24  Approved, 10/24/2023