Compliance Information
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Information on compliance and fraud, waste & abuse

Medical Associates is committed to conducting our business with the highest standards of ethics and integrity. That means every Medical Associates employee, contractor or agent, regardless of their position, is expected to conduct themselves in a professional manner that is free from even the appearance of improper or unethical conduct.

Seven Elements of an Effective Compliance Program

Goal: Prevent, detect and correct noncompliance including Fraud, Waste and Abuse.

  1. Implement Written Policies, Procedures & Standards of Conduct;
  2. Designate a Compliance Officer, Compliance Committee & High Level Oversight
  3. Conduct Effective Training & Education
  4. Develop Effective Lines of Communication
  5. Enforce Standards through Well Publicized Disciplinary Standards
  6. Conduct Internal Monitoring and Auditing and Identify Compliance Risks
  7. Prompt Response to detected Compliance Issues and Undertake Corrective Action

Ways to Report Compliance and Fraud, Waste & Abuse Issues

To report suspected or actual compliance violations, such as fraud, waste, and abuse, HIPAA privacy and security violations, criminal activity, or illegal or unethical conduct occurring within Medical Associates Health Plans, please use one of the methods below.               

By Phone:
Toll Free:
800-747-8900, Option 8 
Local: 563-584-4795

Callers may remain anonymous

By Email:
MAHPComplianceHotline@mahealthcare.com

By Mail:
Medical Associates Health Plan
1605 Associates Drive, Suite 101
Dubuque, IA 52002

Key MAHP Compliance Contacts

  • Zachary Keeling, Compliance Officer
  • Karen Hoffmann, Privacy Officer
  • Jeremy Wulfekuhle, Security Officer

Other Agencies to Report Fraud to:

To report insurance Fraud in Iowa:

To report insurance Fraud in Illinois:

To report insurance Fraud in Wisconsin:

  • Fill out an online complaint form at https://ociaccess.oci.wi.gov/complaints/public/
  • Phone: Office of the Commissioner of Insurance, 800-236-8517 
  • Mail:
    Office of the Commissioner of Insurance
    125 South Webster Street
    P.O. Box 7873
    Madison, WI 53707-7873
  • Fax: 608-264-8115

To report Fraud to the U.S. Department of Health & Human Services Office of Inspector General
Contact the Office of the Inspector General at 1-800-447-8477 or by e-mail to HHSTips@oig.hhs.gov or by mail to the address below.

Office of Inspector General
U.S. Department of Health & Human Services
ATTN: OIG HOTLINE OPERATIONS
PO Box 23489
Washington, DC 20026

What is Fraud, Waste & Abuse?

Fraud is defined as the intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes Fraud under applicable Federal or State law (42 CFR 455.2).

Abuse is defined as provider practices that are inconsistent with sound fiscal, business or medical practices, and result in an unnecessary cost or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.

Waste is defined as deficient practices, systems controls, or decisions that result in using, consuming, spending, or expending goods, services, or funds extravagantly, needlessly, thoughtlessly or carelessly.

Listed below are some general examples of potential Fraud, Waste and Abuse, but this list is not all inclusive:

  • Falsifying Claims
  • Eligibility Determinations Issues
  • Member Eligibility Fraud
  • Misrepresentation of Residency and/or Citizenship Status
  • Billing for Services Not Provided
  • Prescription Alteration/Forgery                
  • Fraudulent Enrollment Practices
  • Misrepresentation of Medical Condition              
  • Fraudulent Credentials
  • Durable Medical Equipment Theft
  • Fraudulent Recoupment Practices
  • Failure to Report Third Party Liability
  • Embezzlement                                                                                

How You Can Help

Take these steps to help protect yourself and others:

  • Protect your health insurance card like you would a credit card. If your card is lost or stolen, contact Member Services immediately at 1-866-821-1365.
  • Closely examine your Explanation of Benefits (EOB) forms to ensure that all the information is accurate and that you received the services reported.
  • Contact Medical Associates to report possible fraud and abuse if you suspect health insurance fraud.

Help Prevent Fraud, Waste and Abuse – Resources for Medicare Beneficiaries 
Protecting Yourself & Medicare from Fraud
Help Fight Medicare Fraud
Identity Theft: Protect Yourself
Identity Theft And Your Social Security Number
Beneficiary Card Sharing Education
What You Need To Know About Misleading Advertising

Helpful Documents
Compliance Program Description
Fraud, Waste & Abuse Policy & Procedure
Code of Conduct
Provider Reference Guide