MMM of Florida’s goal is to behave ethically and with integrity as a leader in the healthcare industry. We work to identify and respond to fraud and other misconduct by third parties that may affect government programs.

Learn how to distinguish between fraud, waste and abuse:

  • Fraud – Is a false representation or scam to obtain unauthorized benefit or wrongly profit.
  • Waste – Occurs when someone incurs in unnecessary, extravagant or negligent costs, or resources are poorly managed.
  • Abuse – Occurs when a provider is inconsistent with good practices in medicine or business. It results in a cost, or in reimbursements for services that are not medically necessary or do not comply with the professional and ethical standards of the health industry.

Examples of potential fraud, waste and abuse:

  • Billing of Non-Rendered Services – It may include billing for services not performed, billing for a higher level of services than the ones performed, billing using inflated procedure codes and overstating patient diagnoses.
  • Alterations in claim forms and clinical records.
  • Billing of providers excluded from participation in federal programs.
  • Billing for non-prescribed/non-dispensed medications.
  • Prescription alterations (such as the type of drugs and quantities).
  • Anti-Kickback – When remuneration is solicited, received or paid in exchange for referrals to provide services that are reimbursable by the federal government.
  • Stark Law – A provider refers a Medicare enrollee to receive some services in a business in which he/she or a family member has financial interests.
  • Beneficiary Inducement Law – Remuneration is offered to influence a beneficiary in choosing a particular provider or supplier.
  • Beneficiary Prescription Abuse – A patient obtains controlled substances by stating a false medical condition. Typically, patients will visit multiple physicians with the same complaint to obtain multiple prescriptions and fill those prescriptions at multiple pharmacies. This allows the patient to illegally obtain narcotics or other controlled substances for personal use or sale.
  • Conflict of Interest – An employee, manager, or executive has an undisclosed economic or personal interest in a transaction. For example, an employee steers a contract to a company the employee or a family member owns, without disclosing the relationship.

If you are aware of any activity similar to the ones mentioned above, or are not sure if an activity is fraud or abuse, please contact us. We will investigate!

  • Call our Hotline: 1-844-481-4937
  • Send us a fax:  1-833-523-2631
  • Write us an email: siu@mmm-fl.com
  • Complete the online form at: https://mmm-fl.ethicspoint.com
  • Write to us at the following address:
    MMM of Florida
    Compliance Department
    P. O. Box 260370
    Miami, FL  33126

You can also make your report anonymously! All information received is treated as confidential, and the results of the investigations will be addressed only by people that have legitimate motives to receive the information (for example, local and federal authorities, and MMM of Florida Directors). In order to do so, please click on the image below.

MMM of Florida, Inc. is an HMO plan with a Medicare contract. Enrollment in MMM of Florida depends on contract renewal. This information is not a complete description of benefits. Call 1-844-212-9858 (TTY: 1-833-523-2620) for more information. Every year, Medicare evaluates plans based on a 5-star rating system.  MMM of Florida, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. MMM of Florida, Inc. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-212-9858 (TTY:1-833-523-2620). MMM of Florida, Inc. konfòm ak lwa sou dwa sivil Federal ki aplikab yo e li pa fè diskriminasyon sou baz ras, koulè, peyi orijin, laj, enfimite oswa sèks. ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-844-212-9858 (TTY:1-833-523-2620).

 

Updated: October 2018

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