Unfortunately, there could be a time when you see Fraud or Abuse related to Vital. Some examples are:
- A person lies about facts to get or keep Vital coverage.
- A doctor bills you or makes you pay cash for covered services.
- A person uses someone else’s ID card.
- A doctor bills for services that you did not get.
- A person sells or gives medications to someone else.
If you find out about Fraud or Abuse, you must tell us about it. You can call First Medical, the Patient’s Advocate Office or ASES. You do not need to tell us your name and we will keep your information private. You will not lose your Vital coverage if you report Fraud or Abuse.
If you want more information, you can visit the ASES website at www.planvitalpr.com. On the website there is a form that you can use to make your report. If you need additional information about Fraud, Waste and Abuse please refer to Fraud, Waste & Abuse section.
You can also help prevent Fraud and Abuse. Here are some things you can do:
- Don’t give your ID card to anyone else.
- Learn about your Vital benefits.
- Keep records of your doctor’s visits, laboratory tests and medications. Make sure you don’t get repeat services.
- Make sure your information is right on a form before you sign it.
- Request and review the quarterly summary of the services you receive. You may request the summary of services directly from First Medical.