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Updated Dec 2011

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Part D (Prescription Drug) Fraud, Waste, and Abuse

As part of the Medicare Modernization Act (MMA) of 2003, the Centers for Medicare and Medicaid Services (CMS) implemented the Medicare Part D benefit for eligible individuals throughout the United States. In order to safeguard this program, CMS contracted with a group of organizations called Medicare Part D Drug Integrity Contractors or MEDICs to detect and prevent Part D fraud and abuse.

Because of this program and oversight, beneficiaries can be assured of receiving quality products and services and that the appropriate level of oversight is in place. Complaints or allegations of fraud, waste, and abuse in the Part D program can be referred to 1-877-7SAFERX or directly to Science Applications International Corporation (SAIC) at:

  • Julio Arias, C.P.A.
  • Benefit Integrity Manager
  • MEDIC West Science Applications International Corporation
  • 450 North Brand
  • Suite 410
  • Glendale, CA 91203
Additional Information or questions regarding SAIC or the MEDIC West may be directed to:
  • Craig Swartz
  • Outreach Manager
  • MEDIC West
  • Science Applications International Corporation
  • 7008 Security Boulevard, Suite 210
  • Baltimore, MD 21244
  • Office Telephone: (571) 241-4723
  • swartzcm@saic.com

Source SAIC e-mail 1/23/2007

Fraud, Waste and Abuse - General Overview

What are Fraud, Waste, and Abuse?

FRAUD is any intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him/her or some other person. It includes any act that constitutes fraud under applicable Federal or State law.

WASTE is unintentional misuse of Medicare funds through inadvertent error, most frequently incorrect coding and billing.

ABUSE (of member) means provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the health plan, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for healthcare. It also includes recipient practices that result in unnecessary cost to the health plan.

For potential Fraud-Waste-Abuse complaints, you may call our Hotline

Examples of fraud, waste, and abuse include letting someone use your ID card to get medical care; a provider who bills for services that you did not receive; getting a prescription that was not prescribed by a licensed and appropriate medical provider; and/or a medical provider physically abusing a Health Choice Generations member.

All organizations that provide Medicare Advantage Plans, like Health Choice Generations, must obey federal laws against retaliation. If you report a fraud, waste, and abuse to Health Choice Generations, it will not affect the medical care you receive.

If you witness any misuse of any ID card, or any other instances of Medicare fraud, waste or abuse, please contact Health Choice Generations FWA Alertline, toll-free at 1-888-677-3720 or TTY - Arizona Relay Service 711. You can call this number any time and leave a confidential message.

Please leave a detailed message regarding the reason for your call and the following information:

  • Your name - please state whether you are a member, provider or employee of Health Choice Generations. If you are a member or provider, please provider you Health Choice Generations plan ID number.
  • Telephone number.
  • The best time to reach you.

You may remain anonymous. You call will receive the same attention whether you identify yourself or not.

PDF Fraud Reporting

PDF Identity Theft Prevention