Compliance Program

Inland Empire Health Plan (IEHP) is committed to conducting its health plan operations in compliance with ethical standards, contractual obligations under State and Federal programs, laws, and regulations applicable to Medi-Cal, IEHP DualChoice, and IEHP Covered.

 

This commitment extends to our business associates, subcontractors, and other associated individuals and entities that support IEHP’s mission to heal and inspire the human spirit. 

Purpose

Sections

Frequently Asked Questions (FAQs)

What are some common examples of fraud?
 

Providers

  • Billing for services not rendered
  • Paying a "kickback" in exchange for a referral for medical services or goods
  • Unbundling
  • Overcharging for services or goods 
  • Using false credentials

Members

  • Allowing unauthorized individuals to use ID card to obtain benefits
  • Altering prescriptions
  • Falsifying residence information to obtain benefits
  • Drug seeking or doctor shopping to obtain narcotics

First, document your suspicions. Then, contact IEHP’s Compliance Department at (866) 355-9038 and make a report with one of our Representatives. At times, IEHP may request additional information that is necessary to investigate.

If you suspect that errors in billing may have occurred, contact your IEHP Provider Services Representative at (909) 890-2054.

  • Periodically perform internal audits of billing practices and compare billing records with payments received.
  • Do not leave prescription pads, which include a Provider's identification and license number, out in the open. For example, do not store prescription pads in exam room cabinets or leave on office counters.

Reporting Information

IEHP has the following methods available for reporting issues related to fraud, waste or abuse, privacy, and IEHP’s Code of Business Conduct & Ethics:

 

Compliance Reporting Methods

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Compliance Hotline

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Website

By clicking on these link, you will be leaving the IEHP website.

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Mail

IEHP Compliance Officer

P.O. Box 1800

Rancho Cucamonga, CA 91729-1800

Contacting the Office of the Inspector General

The Office of the Inspector General (OIG) is there to assist you and maintains a hotline, which offers a confidential means for reporting vital information. For information on confidentiality, please contact the hotline and ask about their confidential source program. Each caller is encouraged to assist the OIG by providing information on how they can be contacted for additional information but the caller may remain anonymous.

 

Contacting the Office of the Inspector General

DHCS Medi-Cal Fraud Hotline

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Phone

The recorded message may be heard in English and 10 other languages: Spanish, Vietnamese, Cantonese, Armenian, Hmong, Cambodian, Laotian, Farsi, Korean and Russian. 

 

The call is free and the caller may remain anonymous.