Fraud, Waste and Abuse

As part of our commitment to improving the healthcare system, ApexHealth has an ongoing commitment to detecting, correcting, and preventing fraud, waste, and abuse. ApexHealth strictly follows Fraud, Waste, and Abuse (FWA) Protocols and all must do the same.

What are fraud, waste, and abuse?

Fraud is an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him or herself or some other person. 

Waste involves the taxpayers not receiving reasonable value for money in connection with any government-funded activities due to an inappropriate omission by an individual with control over or access to government resources. Waste goes beyond fraud and abuse and most waste does not involve a violation of the law. Waste relates primarily to mismanagement, inappropriate actions, and inadequate oversight.

Abuse consists of practices that are inconsistent with sound fiscal, business, or medical practices and result in an unnecessary cost to the Medicaid, Medicare, and Commercial programs or in reimbursement for services that are not medically necessary/fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary costs to the health care programs.

Raising and Reporting Concerns

If you need guidance or become aware of a suspected or detected violation of ApexHealth’s Code of Conduct, Compliance Program, or any related law or policy, you should immediately contact the ApexHealth Compliance team using any of the below reporting mechanisms. In accordance with federal law, ApexHealth prohibits retaliation or intimidation against anyone who, in good faith, reports an ethical or legal concern, regardless of the outcome of the reported concern.

Ethics Help Line Phone: (844) 634-1167

Ethics Help Line Reporting website:

Or scan the QR code below:

Email to ApexHealth’s Medicare Compliance Officer: