Winning Health | Gold Coast Health Plan | Issue 2 | Fall 2021

Fraud, waste and abuse program Millions of taxpayer dollars are wasted every day. This happens when providers bill insurance programs for the wrong services or for services they did not provide. This can be an accident or done on purpose. It is called fraud, waste and abuse. It takes money from programs that are meant to pay for medical care for you and your family. Gold Coast Health Plan (GCHP) is taking steps to identify fraud, waste and abuse. GCHP would like your help to prevent this from occurring in Ventura County. After GCHP has paid your provider, GCHP may send you an Explanation of Benefits (EOB) letter. This letter lists the services a provider says you received and the date you received them. It also shows what services were paid. You will only receive an EOB letter for certain services that were identified for this effort. If you receive an EOB letter, please look at it carefully. Make sure that the services listed match the services you received on that day. If the services listed match the services you received, you do not need to contact GCHP. If the services listed DO NOT match the services you or your family member received, GCHP wants to hear from you. Please call GCHP’s Fraud, Waste and Abuse Hotline at 1-866-672-2615 to report the difference. You can call 24 hours a day, seven days a week. You will be asked about the services you did and did not receive. It is important that we all work together to stop fraud, waste and abuse. Summary Notice of Privacy Practices Gold Coast Health Plan (GCHP) must provide you with a Notice of Privacy Practices (Privacy Notice). The Privacy Notice describes how GCHP uses and shares your health information. This document is a summary of GCHP’s Privacy Notice. How GCHP uses and shares your information GCHP uses and shares your information to provide you with health benefits. GCHP uses or shares your information to: ● Provide for your treatment. ● Pay for your health services. ● Run the health plan and contact you when necessary. ● Comply with the law. ● Help with public health and safety issues. ● Respond to lawsuits and legal actions. ● Carry out other purposes as required or permitted by law. Please refer to the GCHP Privacy Notice for more information. Your privacy rights When it comes to your health information, you have the right to: ● Get a copy of the GCHP Privacy Notice. ● Get a copy of your health and claims records. ● Ask GCHP to correct your health and claims records. ● Get a list of certain people or places GCHP has shared information with. ● Request confidential communications. ● Ask GCHP to limit what it uses or shares. ● File a complaint if you feel your rights are violated. GCHP’s legal duties GCHP is required to: ● Keep your health information private. ● Follow the terms of the Privacy Notice. A full list of GCHP’s duties is provided in the Privacy Notice. You can acquire a copy of the GCHP Privacy Notice by going to the website, goldcoasthealthplan.org , or by contacting Member Services at 1-888-301-1228 /TTY 1-888- 310‑7347 to obtain a paper copy.