Back to Insights and Updates for ProvidersApril 2023

Point32Health Fraud, Waste, and Abuse Payment Policy

All products

We’ve developed an integrated Point32Health Fraud, Waste, and Abuse Payment Policy, in an effort to offer information pertaining to Harvard Pilgrim Health Care and Tufts Health Plan policies and procedures streamlined in one comprehensive document.

The policy outlines Point32Health’s commitment to protecting the interests of all our constituents (members, employers, and providers), as well as our corporate assets, against those who knowingly and willingly commit fraud. This commitment includes detecting, investigating, and preventing wrongful acts committed by our constituents or any other entity against the organization; recovering funds; and reporting suspected fraud, waste, and/or abuse — or taking legal action, if appropriate.

All providers are required to comply with all federal and state laws and regulations prohibiting fraudulent acts, kickbacks, and false reporting. The policy offers guidelines around submitting claims/billing in a manner that is compliant with relevant regulations, and identifies examples of provider behavior that would constitute fraud, waste, or abuse.

Please be sure to review the information outlined in this payment policy, as Point32Health reserves the right to conduct audits on any provider or facility to ensure compliance with the policy, and will expect the provider/facility to refund all payment related to any noncompliance uncovered by such audits.

In addition, if you know of or suspect any fraud, waste, or abuse activity, please call Point32Health’s Compliance and Fraud, Waste, and Abuse Hotline at 1.877.824.7123.

Audrey Kleinberg
Director, Provider Relations & Communications

Annmarie Dadoly
Senior Manager, Provider Communications

Joseph O’Riordan, Jesse Salvato, Stephen Wong

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Production Coordinator

Kristina Cicelova
Graphic Designer