Legal & Compliance
Bright Health is committed to investigating and correcting Fraud, Waste and Abuse. Preventing Fraud, Waste and Abuse helps to keep healthcare affordable. We encourage our members, providers, employees and other parties to report suspected unethical or illegal conduct or suspected Fraud, Waste & Abuse.
What are Fraud, Waste and Abuse?
Fraud is an intentional deception or misrepresentation made by a person, knowing that the deception could result in some unauthorized benefit to oneself or another person. It includes any act that constitutes fraud under applicable federal or state law.
Waste is participating in practices that result in unnecessary costs to a healthcare system, such as over-utilizing services or misusing resources.
Abuse is when a person is involved in practices that are inconsistent with sound, fiscal business or medical practices. These practices may result in an unnecessary cost to a health plan or in reimbursement for services that are not Medically Necessary or that do not meet professionally recognized standards for healthcare.
Reporting Potential Fraud, Waste & Abuse, or Suspicious Activity
If you think that insurance fraud, waste, abuse, or other suspicious activity has occurred, may be occurring, or is going to occur, please report it immediately. To report suspected fraud, waste, abuse or other suspicious activity, call Bright Health’s Compliance Hotline at: (855) 208-3766. If you report suspicious or fraudulent activity, be sure to include as much detail as possible with your report so we can investigate the issue. Reports can be made anonymously. All reports are treated as confidential and will be investigated. We will not release your personal information unless we are required to do so, for example, under court rule or subpoena. We may refer the activity to law enforcement or to the appropriate regulatory body. Members or Providers that are found to be engaging in suspicious activity, fraud or abuse are subject to removal from the plan and recovery of any overpayments.