Prevention of fraud, waste, and abuse

Preventing, detecting, and correcting fraud, waste, and abuse (FWA) is the shared responsibility of everyone involved in providing health care and coverage. Below, please find Kaiser Permanente's expectations for delivering excellent care and service to patients while minimizing risks to yourself and Kaiser Permanente.

Compliance expectations and measures include:

  • Accurately and completely document in-patient medical records. A claim for services must be supported by the documentation in medical records.
  • Do not falsify or misrepresent information on a prescription.
  • Know and abide by all applicable laws and regulations.
  • Address FWA in your practice with appropriate internal policies and procedures.
  • Protect all patient and business information from inappropriate or unauthorized use or disclosure.
  • Retain adequate records of employee training for 10 years.
  • Strive for accuracy and excellence in service, coding, and billing.
    • Do not up-code.
    • Do not unbundle services.
    • Provide only medically necessary services.
    • Do not bill for services not rendered.
    • Do not submit duplicate billing.
  • Watch for suspicious activity and red flags.
  • Do not retaliate against your own employees who report FWA concerns in good faith.

It is important to report FWA concerns in a timely manner. To report a concern or ask a question, please contact the Kaiser Permanente Compliance Hotline at:
1-888-774-9100.

Content on this page is from the provider manual. | Disclaimer