Fraud, Waste and Abuse

First Health Colorado needs ICHP, to let our members know about Abuse and Fraud. Abuse is any action that results in unneeded costs to Health First Colorado. Fraud is making a false statement or falsifying information to get something that helps oneself or someone else. There can be two types of fraud:

PROVIDER FRAUD

  • Billing for doctor visits, medical procedures, drugs or supplies that are not provided to a Health First Colorado member
  • Billing for the same service twice

MEMBER FRAUD

  • Eligibility Determination Fraud
    • Unreported Income
    • Household Composition
    • Resource Misrepresentation (Transfer/Hiding)
    • Residency (lives outside the state of Colorado)
    • Citizenship Status
  • Other Types of Fraud
    • Using another person’s Health First Colorado card
    • Selling or buying a Health First Colorado card
    • Forging prescriptions
    • Concealing access to other health insurance
    • Misrepresenting a medical condition
    • Going to different medical providers, with the intent to deceive, in search of a controlled substance
    • Giving your prescriptions to others
    • Selling supplies provided by Health First Colorado to others

What is waste?

Over-utilizing Health First Colorado services, supplied or equipment, or causing unnecessary costs through carelessness or inefficiency.


What is abuse?

Activities that result in unnecessary costs to Health First Colorado.

If you think someone is committing fraud and abuse, you can contact:

  • Compliance Officer at your PCP office
  • ICHP Compliance Officer at 855-899-7148
  • Health First Colorado Provider Fraud:
    • Call 855-375-2500
    • Send an email to ReportProviderFraud@hcpf.state.co.us
    • Send a fax to 303-866-4411, or
    • Mail information to:
      Department of Health Care Policy & Financing
      Attn: Program Integrity Section
      1570 Grant Street
      Denver, CO 80203
  • Health First Colorado Member Fraud:
    • Submit the online Health First Colorado Member Fraud Form
    • Call 844-475-0444
    • Send an email to Report.ClientFraud@state.co.us
    • Send a fax to 303-866-4411, or
    • Mail information to:
      Department of Health Care Policy & Financing
      Attn: Audit Information Management Section
      1570 Grant Street
      Denver, CO 80203

Abuse

Elder Abuse:

  • Colorado Coalition for Elder Rights and Abuse Prevention
    • Email: info@ccerap.org
    • Write: 789 Sherman Street, Suite 250 Denver, Colorado 80230 USA
  • Adult Protective Services: Download Document

Child Abuse:

  • To report child abuse in any Colorado county use this link County listings or dial 911.
  • 1-844-CO-4-Kids to report child abuse and neglect