Inside SFHP

Member Fraud Awareness

SFHP has a Health Care Fraud Awareness Program that identifies, prevents, and fights Fraud, Waste, and Abuse.

You Can Stop Fraud, Waste, and Abuse

Health care fraud, waste, and abuse costs billions of dollars each year. You can help stop fraud by telling us about it.

What is Health Care Fraud?

Health care fraud can include making false statements on purpose, misrepresentations, or planned omissions to get payment, services, or money for health care services for which someone is not allowed.

Examples of Member Fraud:

  • Giving information that is not true when signing up for programs or services.
  • Getting prescriptions with the goal of abusing or selling them.
  • Letting someone else use your health care ID card.

Examples of Provider Fraud:

  • Providers giving unneeded services in order to bill for them.
  • A health care provider bills for services you never received.
  • Providers billing for more costly services than they in fact gave.

Examples of Pharmacy Fraud:

  • A Pharmacy gives medications without members calling in for refills.
  • A company offers a Medi-Cal drug plan that has not been approved by Medi-Cal.
  • A Pharmacy bills Medi-Cal for home medical equipment after it has been returned.

If you suspect health care fraud, waste, or abuse, report it.

San Francisco Health Plan Hotline: 1(800) 461-9330
California Department of Health Care Services (DHCS)
Phone: 1(800) 822-6222