Fraud and Compliance Concerns

What is fraud?

Fraud is a serious matter. 

Fraud is illegal. It is not telling the truth so you can get the money that you do not deserve.

An example of fraud for enrollees is: 

• Claiming that you live in D.C., but you do not. 

An example of fraud for providers is: 

• Billing for services and supplies that were not provided.

Please let us know if you suspect fraud. HSCSN Grievance, Appeals, and Compliance Hotline is a confidential service.

You can do this anonymously.

Concerns may be reported directly to:

• HSCSN Grievance, Appeals and Compliance Hotline at 1 (844) 556-9152
• HSCSN Customer Care at 202-467-2737
• The D.C. Department of Health Care Finance’s Fraud Hotline at 1 (877) 632-2873

HSCSN is committed to:

• Following the law
• Honesty, integrity, and high ethical standards in the conduct of its business.
• Investigating your concerns and resolving them quickly. 

Anyone can report a concern about the HSCSN Code of Conduct. 

What should be reported to the Compliance Department?

• Violations of HSCSN’s Policies & Ethics
• Fraud, Waste, and Abuse
• Code of Conduct Violations
• Conflict of Interest
• Privacy & HIPAA Issues

Please let us know if you suspect a violation of conduct. It is not required for you to identify yourself or give your name. You will not be punished for filing a complaint.  

To file a complaint with the Secretary of the Department of Health and Human Services:

• Send a letter to 200 Independence Avenue, SW, Washington, D.C. 20201
• Call 1(877) 696-6775

To file a complaint with our office:

• Call Customer Care / HSCSN Compliance & Privacy Officer at 202-467-2737
• Mail a letter to the HSCSN office at 1101 Vermont Avenue NW, Suite 1200, Washington, D.C. 20005