Eye Management (EMI) wants to find and stop health care fraud and abuse. It is estimated that billions of dollars are lost annually due to health care fraud and abuse. EMI takes its responsibility seriously to protect the integrity of the care its members receive, its Health Plans, and the Federal and State Programs it administers.
Fraud is defined as any deliberate and dishonest act committed with the knowledge that it could result in an unauthorized benefit to the person committing the act or someone else who is similarly not entitled to the benefit. Examples of healthcare fraud are:
Abuse is defined as practices that are inconsistent with accepted sound fiscal, business, or medical practices, and result in an unnecessary cost or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.
Both fraud and abuse can expose a provider or vendor to criminal and civil liability.
All EMI providers are required to report concerns about actual, potential or perceived misconduct to the EMI Corporate Compliance Department at the numbers/addresses noted above.
EMI takes its responsibility to protect your reporting of actual or suspected fraud and abuse seriously. No employee may threaten, coerce, harass, retaliate, or discriminate against any individual who reports a compliance concern. To support this effort, EMI has enacted zero-tolerance policies and annually trains all personnel on their obligation to uphold the highest integrity when handling compliance related matters. Any individual who reports a compliance concern has the right to remain anonymous and EMI commits to enforcing this right.