Fraud, Waste and Abuse Compliance

The Office of Management and Enterprise Services Employees Group Insurance Division (EGID) is committed to conducting its business activities with integrity and in full compliance with the federal, state and local laws governing its business. This commitment applies to relationships with members, providers, auditors and all public and government bodies. Most importantly, it applies to employees, subcontractors and representatives of EGID. This commitment includes the policy that all such individuals have an obligation to report problems or concerns involving ethical or compliance violations related to its business.

If you suspect that EGID has been defrauded or is being defrauded or that resources have been wasted or abused, report the matter to the EGID Program Integrity Unit immediately. You can report suspicious acts or claims by:

Sending a report in writing to:
EGID Program Integrity Unit
2401 N. Lincoln Blvd., Ste. 300
Oklahoma City, OK 73105
Emailing a message to EGID.antifraud@omes.ok.gov.
Calling the EGID toll-free hotline at 866-381-3815.
Visiting the EGID Program Integrity Unit in person.

Access the Compliance Plan and OMES Code of Ethics.

Individuals are encouraged to provide adequate information in order to assist with further investigation of fraud. All investigations will be handled confidentially. Every attempt will be made to ensure the confidentiality of any report, but please remember that confidentiality may not be guaranteed if law enforcement becomes involved. There will be no retaliation against anyone who reports conduct that a reasonable person acting in good faith would have believed to be fraudulent or abusive.

Any employee who violates the non-retaliation policy will be subject to disciplinary action up to and including termination.

Examples of fraud, waste and abuse may include:

An individual or organization pretends to represent HealthChoice, Medicare and/or Social Security, and asks you for your HealthChoice member ID, Medicare or Social Security number, bank account number, credit card number, money, etc.
Someone asked you to sell your prescription drug card or the account information on the card.
Someone asks you to get medications for them using your prescription drug card or prescription coverage.
You are encouraged to disenroll from your plan.
You are offered cash or a gift worth more than $15 to sign up for a Medicare prescription drug plan.
Your pharmacy does not give you all of your medications.
You are billed for medications or health services that you did not receive.
You are charged more than once for your insurance premium.
Your prescription drug plan does not pay for your covered medications.
You receive a different medication than your doctor ordered.

You can contact EGID at 866-381-3815 to report complaints about one of these types of fraud, waste and abuse issues or a related complaint.

If you have a general question or concern related to your insurance benefits and it is not a potential fraud, waste or abuse issue, please contact HealthChoice at 405-717-8780 or toll-free 800-752-9475. TDD users call 405-949-2281 or toll-free 866-447-0436.