Fraud, Waste and Abuse
LSF Health Systems (LSFHS) reviews and investigates all allegations of suspected and or confirmed fraud, waste and abuse; enforces the appropriate corrective actions to remedy any allegations; reports the confirmed fraud, waste and abuse to the appropriate authorities and ensures that all employees, network service providers and subcontractors comply with applicable federal, state, local, LSFHS and Department of Children and Families (DCF) contract requirements.
If you suspect Fraud, Waste and Abuse, please take into consideration the following definitions:
Fraud: Knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program. (18 U.S.C. § 1347)
Waste: Overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the system of care. It is not generally considered to be caused by criminally negligent actions; rather, waste relates primarily to mismanagement, inappropriate actions and inadequate oversight.
Abuse: Involves behavior that is deficient or improper when compared with behavior that a prudent person would consider reasonable and necessary business practice given the facts and circumstances. Abuse also includes misuse of authority or position for personal financial interests or those of an immediate or close family member or business associate. Abuse does not necessarily involve fraud, violation of laws, regulations or provisions of a contract or grant agreement. Payment of incentive and award fees in circumstances where the contractor’s performance in terms of cost, schedule and quality outcomes does not justify the fees is an example of contracting waste. In comparison, an example of contracting abuse would include making procurement or vendor selections that are contrary to existing policies or unnecessarily extravagant or expensive.
Some examples of fraud, waste and abuse may involve:
- Contract Fraud and Mismanagement
- Conflict of Interest
- Misuse of Position or Property
- Improper use of Public Funds
- Violations of Law, Rule, or Procedure
- Inappropriate Acts and/or Omission that results in client injury, abuse, neglect or death
- Inappropriate Billing
To report suspected fraud, waste and abuse to LSFHS, you may choose one of several options:
To submit paper format click here. Print the form and send it via mail to:
Attention: Compliance Officer, LSF Health System, Inc.
9428 Baymeadows Rd., Bldg. III, Suite 320, Jacksonville, Florida 32256
You can also contact the Office of the Florida Inspector General at:
Attention: Compliance Officer
1317 Winewood Blvd., Bldg. 5, Second Floor, Tallahassee, FL 32399-0700
Phone: (850) 488-1225 or Fax: (850) 488-1428
You can leave a voicemail at (904) 337 – 4059 or email compliance@lsfnet.org
