Attention! Nationwide recall of certain apple sauce pouches due to possible contamination with lead. Learn more.

Effective July 15th, Health Services for Children with Special Needs (HSCSN) will implement Optum Financial/Optum Pay as the check payment vendor for provider electronic funds transfer (EFT). The details to the provider letter can be found in this document.

Fraud and Compliance Concerns

What is fraud?

Fraud is a serious matter. 

Fraud is illegal. It is not telling the truth so you can get the money that you do not deserve.

An example of fraud for enrollees is: 

  • Claiming that you live in D.C., but you do not. 

An example of fraud for providers is: 

  • Billing for services and supplies that were not provided.

Please let us know if you suspect fraud. HSCSN Grievance, Appeals, and Compliance Hotline is a confidential service.

You can do this anonymously.

Concerns may be reported directly to:

  • HSCSN Grievance, Appeals and Compliance Hotline at 1 (844) 556-9152
  • HSCSN Customer Care at 202-467-2737
  • The D.C. Department of Health Care Finance’s Fraud Hotline at 1 (877) 632-2873

Compliance

HSCSN is committed to:

  • Following the law
  • Honesty, integrity, and high ethical standards in the conduct of its business.
  • Investigating your concerns and resolving them quickly. 

Anyone can report a concern about the HSCSN Code of Conduct. 

 

What should be reported to the Compliance Department?

  • Violations of HSCSN’s Policies & Ethics
  • Fraud, Waste, and Abuse
  • Code of Conduct Violations
  • Conflict of Interest
  • Privacy & HIPAA Issues

For More Information or to Report a Complaint

Please let us know if you suspect a violation of conduct. It is not required for you to identify yourself or give your name. You will not be punished for filing a complaint.  

To file a complaint with the Secretary of the Department of Health and Human Services:

  • Send a letter to 200 Independence Avenue, SW, Washington, D.C. 20201
  • Call 1(877) 696-6775

To file a complaint with our office:

  • Call Customer Care / HSCSN Compliance & Privacy Officer at 202-467-2737
  • Mail a letter to the HSCSN office at 1101 Vermont Avenue NW, Suite 1200, Washington, D.C. 20005