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Member Rights

Friday Health Plans is committed to the highest level of quality and ethical standards and to ensuring that all its business is conducted in compliance with Federal, State and local laws and within applicable regulatory guidelines.

Friday Health Plans will take appropriate disciplinary action against employees, providers, subcontractors, consultants, and agents found to have violated Friday Health Plans policies or the Code of Conduct and/or committed Fraud, Waste or Abuse.

Fraud, Waste and Abuse

As part of the Friday Health Plans compliance program, we have an obligation to report known or suspected fraud, waste and abuse. We use the terms “fraud,” “waste,” and “abuse” defined below as applied to our business.

Fraud – An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him/herself or some other person. It includes any act that constitutes fraud under applicable Federal or State law.

Waste – Overutilization of services, or other practices that result in unnecessary costs. Generally not considered caused by criminally negligent actions but rather misuse of resources.

Abuse – An individual’s activities that are inconsistent with sound fiscal, business or medical practices that result in an unnecessary cost, reimbursement for services that are not medical necessary or fail to meet professionally recognized standards for health care.

Report Compliance Issues

For good faith, anonymous reporting of any compliance concerns, including fraud, waste or abuse or other compliance-related matters, please call our Compliance Hotline at 888-533-3696. You do not need to give your name.

Compliance Links

Please click on the links below for additional information.

Notice of Privacy Practices

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