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BenefitMall Anti-Fraud Plan

BenefitMall (Mather & Strohl) Anti-Fraud Plan

BenefitMall is committed to helping fight against health care fraud and abuse. We offer a variety of education and training material on fraud and abuse.

Listed below are just some of the steps BenefitMall has taken to combat health care fraud and abuse:

Fraud and abuse cost taxpayers billions of dollars and put beneficiaries’ health and welfare at risk. It is estimated that 60 billion dollars are lost annually due to health care fraud and abuse. All BenefitMall’s employees, subcontractors, and vendors are required to report any suspicious fraud and abuse activity to our compliance team.

What is Health Care Fraud and Abuse?

According to the department of Health and Human Services Centers for Medicare & Medicaid services, fraud is defined as making false statements or representations of material facts to obtain some benefit or payment for which no entitlement would otherwise exist. These acts may be committed either for the person’s own benefit or for the benefit of some other party. Fraud includes the obtaining of something of value through misrepresentation or concealment of material facts. Fraud schemes range from solo to broad-based operations by an institution or group.

Anyone can commit health care fraud. Fraud is defined as intentionally executing, or attempting to execute, a plan to obtain money or value from Medicare using deception. Examples of health care fraud include but are not limited to the following:

Abuse is defined as actions or practices that directly or indirectly result in unnecessary cost to the Medicare Program, and that do not provide patients with medically necessary services or meet professionally recognized standards of care. Examples of health care abuse include, but are not limited to the following:

The difference between fraud and abuse depends on the specific facts, circumstances, intent, and knowledge. Both are considered non-compliance. Fraud and abuse can also expose our employees and our health care vendors or providers to criminal and/or civil liability.

How to prevent fraud and abuse?

Having awareness of health care fraud and abuse

How to report fraud and abuse?

To aid in the investigation of any allegation of fraud and abuse, BenefitMall must have the following information:

Note: It is important to provide BenefitMall with your name, phone number, and address in the event we may have additional questions regarding your allegation. At BenefitMall, reports are treated confidentially and may be made anonymously.

You may file your request by one of the following resources listed below:

  1. Send an e-mail: Compliance@benefitmall.com
  2. Mail your information to our corporate address listed below:
    BenefitMall Compliance Department, 12404 Park Central Drive, Suite 400S, Dallas, TX 75251
  3. Contact our BenefitMall Ethics Hotline at: 855-819-1247

At BenefitMall, we take responsibility to protect your reporting of suspected fraud and abuse seriously. No one may threaten, retaliate, harass, or discriminate against any individual who reports a compliance concern.

Additional Resources

CMS Training Courses:


Medicare Fraud, Waste, & Abuse, Training Presentation:


Training Modules include: