Report Fraud, Waste, & Abuse

What is FWA?

Fraud: Healthcare fraud is when someone knowingly and intentionally creates a scheme or artifice to defraud a healthcare benefit program OR to obtain money and/or property of a healthcare benefit program through false pretenses, promises, or representations.

People who commit fraud know their acts are wrong.

Waste: Healthcare waste is when someone’s practices include the over-utilization or practices, procedures, or products and result in unnecessary costs to a healthcare benefit program. These practices are unintentionally wasteful and are really a misuse of resources.

Abuse: Healthcare abuse is when someone’s practices bring about payments for items or services that they are not legally entitled to, therefore resulting in unnecessary costs to a healthcare benefit program. The difference between abuse and fraud is that people who commit abuse do not know they have misrepresented facts to receive payments.

How to Report FWA

No matter how you report, you are not required to provide your name or any contact information, however, please include enough detail about the situation so Capital Rx can investigate thoroughly.

To report suspected FWA directly to the Special Investigations Unit, email FWA@cap-rx.com.

To report suspected FWA anonymously, contact our 24/7 anonymous reporting vendor.

Toll-free Telephone:
English speaking USA and Canada: 855-222-0934
Spanish speaking USA and Canada: 800-216-1288
Spanish speaking Mexico: 01-800-681-5340
French speaking Canada: 855-725-0002