{"id":14569,"date":"2022-08-10T13:01:10","date_gmt":"2022-08-10T13:01:10","guid":{"rendered":"https:\/\/ppmco.foxtrotdev.com\/el-fraude-medico\/"},"modified":"2023-07-25T19:31:27","modified_gmt":"2023-07-25T19:31:27","slug":"el-fraude-medico","status":"publish","type":"page","link":"https:\/\/ppmco.foxtrotdev.com\/es\/el-fraude-medico\/","title":{"rendered":"El Fraude Medico"},"content":{"rendered":"<div id=\"block_e06013aec0faa9d10eced1686a17f07e\" class=\"wpfox-page-header simple\" style=\"\">\r\n\t<div class=\"wrapper banner\">\r\n\t\t<div class=\"bg-glow\"><\/div>\r\n\t\t\t\t<div class=\"text-block\">\r\n\t\t\t\n\n<h1 class=\"wp-block-heading page-title has-h-3-font-size\">El Fraude Medico<\/h1>\n\n\n\n<h2 class=\"wp-block-heading has-h-1-font-size\">Lo que debe saber<\/h2>\n\n\r\n\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t<\/div>\n\n\n<div class=\"wp-block-group is-style-section-padding is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"is-style-default has-intro-font-size\">El fraude es el enga\u00f1o intencional para acceder a una ganancia injusta o ilegal, o para privar a alguien de un derecho legal. Se estima que cada a\u00f1o se pierden m\u00e1s de $60 mil millones debido a estrategias de fraude en la atenci\u00f3n m\u00e9dica.  <\/p>\n\n\n\n<p class=\"is-style-default\">Priority Partners desea que USTED sea parte de la lucha contra el fraude en la atenci\u00f3n m\u00e9dica e informe actividades sospechosas.<br>Estos son algunos ejemplos de fraudes en la atenci\u00f3n m\u00e9dica que podr\u00eda encontrar:<\/p>\n\n\n\n<ul class=\"is-style-default wp-block-list\">\n<li>Cuando un proveedor factura servicios que no proporcion\u00f3 o productos que no brind\u00f3<\/li>\n\n\n\n<li>Cuando un proveedor factura productos o servicios que no son m\u00e9dicamente necesarios<\/li>\n\n\n\n<li>Cuando un paciente vende medicamentos o elementos que solo est\u00e1n destinados para \u00e9l\/ella<\/li>\n\n\n\n<li>Cuando un paciente obtiene muchas recetas para el mismo medicamento de parte de varios m\u00e9dicos durante el mismo per\u00edodo<\/li>\n\n\n\n<li>Cuando una persona falsifica o cambia los formularios de receta m\u00e9dica<\/li>\n<\/ul>\n\n\n\n<p class=\"is-style-default\">La Unidad de Investigaciones Especiales (UIE) de Priority Partners investiga las denuncias de sospecha de fraude a la atenci\u00f3n m\u00e9dica. Luego estos resultados se dan al Departamento de Salud e Higiene Mental de Maryland (Maryland Department of Health and Mental Hygiene \u2013 DHMH). Puede que DHMH haga su propia investigaci\u00f3n y que tome medidas contra los que cometieron el fraude.  <\/p>\n\n\n\n<h4 class=\"wp-block-heading\">\u00bfC\u00d3MO PUEDO AYUDAR?<\/h4>\n\n\n\n<p class=\"is-style-default\">Usted puede reducir los casos del fraude m\u00e9dico por seguir estas reglas simples:<\/p>\n\n\n\n<ul class=\"is-style-default wp-block-list\">\n<li>Nunca preste su tarjeta de asistencia m\u00e9dica a nadie<\/li>\n\n\n\n<li>Guarde su n\u00famero de asistencia m\u00e9dica como guardar\u00eda su n\u00famero de seguro social<\/li>\n\n\n\n<li>Siga todas las reglas de asistencia m\u00e9dica<\/li>\n\n\n\n<li>Reporte cualquier sospecha de fraude (incluyendo los ejemplos que se citan m\u00e1s arriba)<\/li>\n\n\n\n<li>Reporte las tarjetas de asistencia m\u00e9dica perdidas o robadas al Departamento de Servicio al Cliente de Priority Partners al <a href=\"tel:8006549728\">800-654-9728<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Recuerde que el fraude m\u00e9dico afecta a todos.<\/h4>\n\n\n\n<p class=\"is-style-default\">Si cree que alguien est\u00e1 cometiendo fraude contra Priority Partners o el Programa de Asistencia M\u00e9dica de Maryland, por favor reporte el acto a Priority Partners, DHMH o el Departamento de Servicios Sociales. Todas las denuncias de fraude se mantienen confidenciales. Priority Partners est\u00e1 cometido a seguir todas las leyes y normas aplicables, en particular las que tratan el fraude m\u00e9dico, el desperdicio, el abuso y la facturaci\u00f3n indebida de servicios de atenci\u00f3n m\u00e9dica.  <\/p>\n\n\n\n<h4 class=\"wp-block-heading\">\u00bfQu\u00e9 me sucede si reporto una inquietud?<\/h4>\n\n\n\n<p class=\"is-style-default\">\u00a1Priority Partners toma muy en serio su responsabilidad de proteger su derecho a reportar! Ning\u00fan empleado de Priority Partners puede amenazar, coaccionar, acosar, tomar represalias o discriminar a cualquier individuo que que informe una sospecha de fraude, desecho o abuso. Para apoyar este esfuerzo, el Plan M\u00e9dico ha promulgado p\u00f3lizas de tolerancia cero y entrena anualmente a <em>todo<\/em> personal sobre su obligaci\u00f3n a mantener la integridad cuando est\u00e1 tratando con los asuntos relacionados al cumplimiento. \u00a1Cualquier individuo que reporta una inquietud de cumplimiento tiene el derecho a permanecer an\u00f3nimo y Priority Partners se comete a hacer respetar este derecho!   <\/p>\n\n\n\n<h4 class=\"wp-block-heading\">\u00bfC\u00d3MO PUEDO REPORTAR EL FRAUDE?<\/h4>\n\n\n\n<p class=\"is-style-default\">\u00a1Reportar es simple! Puede reportar por medio de la Organizaci\u00f3n de Atenci\u00f3n Administrada (Managed Care Organization \u2013 MCO), el Departamento de Salud e Higiene Mental o el Departamento de Servicios Sociales (DSS). <\/p>\n\n\n\n<p class=\"is-style-default\">Puede ponerse en contacto con el Departamento de Cumplimiento de Priority Partners por una de las siguientes maneras:<\/p>\n\n\n\n<p class=\"is-style-default\"><strong>Llame a la l\u00ednea directa:<\/strong> <a href=\"tel:4104244971\">410-424-4971<\/a><br><strong>Escribir: <\/strong>Johns Hopkins Health Plans Program and Payment Integrity<br>Attention: Special Investigations Unit<br>7231 Parkway Drive<br>Hanover, MD 21076<br><strong>Correo Electr\u00f3nico:<\/strong> <a href=\"mailto:FWA@jhhp.org\">FWA@jhhp.org<\/a><br><strong>Fax:<\/strong> <a href=\"fax:4104242708\">410-424-2708<\/a><\/p>\n\n\n\n<p class=\"is-style-default\"><strong>Puede ponerse en contacto con DHMH por una de las siguientes maneras:<\/strong><\/p>\n\n\n\n<p class=\"is-style-default\"><strong>Llamar:<\/strong> Llame a DHMH directamente al <a href=\"tel:8002844510\">800-284-4510<\/a> o al Inspector General al <a href=\"tel:8667707175\">866-770-7175<\/a><br><strong>Escribir:<\/strong> MDH Program Integrity Unit, 201 West Preston Street, Baltimore, Maryland 21201<\/p>\n\n\n\n<p class=\"is-style-default\">Tambi\u00e9n puede reportar el fraude a su Departamento de Servicios Sociales local.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>El fraude es el enga\u00f1o intencional para acceder a una ganancia injusta o ilegal, o para privar a alguien de&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"14918,15524,14942,12127,12290,12185","_relevanssi_noindex_reason":"","inline_featured_image":false,"footnotes":""},"class_list":["post-14569","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.6 - 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