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Fraud, Waste and Abuse

False Claims Act

The False Claims Act is aimed at establishing a law enforcement partnership between federal law enforcement officials and private citizens who learn of fraud against the Government. Under the False Claims Act, those who knowingly submit, or cause another person or entity to submit, false claims for payment of government funds are liable for up to three times the government's damages plus civil monetary penalties. The False Claims Act explicitly excludes tax fraud.

The Act permits a person with knowledge of fraud against the United States Government to file a lawsuit on behalf of the Government against the person or business that committed the fraud. The lawsuit is known as a "qui tam" case, but it is more commonly referred to as a "whistleblower" case. If the lawsuit is successful, the qui tam plaintiff is rewarded with a percentage of the recovery, typically between 15 and 25%. Any person who files a qui tam lawsuit in good faith is protected by law from any threats, harassment, abuse, intimidation or coercion by his or her employer. For more information on the False Claims Act, please contact the Meridian

Corporate Compliance Officer at 1-844-667-3560 (TTY: 711).

Jimmo v. Sebelius Information

On January 24, 2013, the U.S District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius. The settlement clarifies skilled care delivery for skilled nursing facilities (SNFs), home health (HH), inpatient rehabilitation (IRFs), and outpatient therapy (OPT) benefits. The Centers for Medicare and Medicaid Services (CMS) has instructed Medicare insurers like Meridian Health Plan to convey this information to our providers to ensure that services are provided and coverage determinations are adjudicated accurately and appropriately in accordance with associated policy.

For documentation requirements, revisions to relevant portions of the Medicare Benefit Policy Manual, frequently asked questions and their responses, please visit the CMS website or review the following materials below:

Updated Date: 10/01/24

H6080_WEBSITE_2025_Accepted_09302024


Updated Date: 10/01/24

H6080_WEBSITE_2025_Accepted_09302024

Meridian Medicare-Medicaid Plan (MMP) is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Meridian Member Handbook. Out-of-network/non-contracted providers are under no obligation to treat Meridian members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services. You can get this document for free in other formats, such as large print, braille, or audio. Call 1-855-580-1689 (TTY: 711). Representatives are available Monday-Friday, 8 a.m. to 8 p.m. to assist you. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

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