Policies and Procedures

HealthTeam Advantage is committed to detecting and fighting healthcare fraud. Working with law enforcement when necessary, HealthTeam Advantage evaluates all allegations of fraud, waste, and abuse.

You can help us fight fraud by paying close attention to your medical and prescription drug benefits. Review every Explanation of Benefits (EOB) for accuracy. If you find a suspicious charge on your EOB or Medicare Summary Notice (MSN), call your provider first. It could be a simple error that can be easily corrected. If you still suspect fraud after speaking with them, you can contact HealthTeam Advantage at 1-888-965-1965 (TTY 711). HealthTeam Advantage employees are trained in detecting fraud, waste, and abuse and will evaluate your call and determine the appropriate course of action.

To report healthcare fraud, waste, or abuse, call the HealthTeam Advantage Compliance Helpline at 1-855-741-4518. Reports made through the compliance hotline can be made confidentially or anonymously, 24 hours a day, 7 days a week. To submit a written report, write to: HealthTeam Advantage, Attn: Compliance Department, 300 E. Wendover Ave., Suite 121, Greensboro, NC 27401.

You can also contact the Office of the Inspector General Hotline; this provides a confidential means to report information.

Examples of potentially fraudulent activities

• You did not receive a medication listed on your EOB.
• You received a different drug than what is listed on your EOB.
• You received a different quantity of drug than what is listed on your EOB.
• Someone asked you to sell your member ID card.
• Someone asked you to use your member ID card.
• Someone offered you cash to purchase a prescription drug or to disenroll from your current plan.