The National Committee for Quality Assurance (NCQA) takes fraud and misconduct seriously. NCQA does not tolerate fraudulent, misleading, or improper information submitted by organizations as part of their survey process, or any other program. NCQA requires accurate and complete information to support compliance with NCQA Standards and Guidelines. Submitting of any Falsified Document or Fraudulent Information may be grounds for suspension, denial or revocation of NCQA’s status determination. NCQA defines these terms as follows:
- Falsified Documents are documents provided by an applicant that have been redrafted, reformatted or fabricated, in whole or in part, with false or misleading information to substantiate compliance with NCQA Standards and Guidelines.
- Fraudulent Information includes oral statements made by an applicant or another accredited, certified or recognized person on behalf of the applicant to substantiate compliance with NCQA Standards and Guidelines or to otherwise influence the outcome of an NCQA survey, which are false or otherwise misleading.
To provide a secure manner to report allegations that Falsified Documents or Fraudulent Information have been supplied to NCQA, NCQA is making available its confidential Reporting Hotline. The Reporting Hotline is set up through Lighthouse Services and is not equipped with caller identification, allowing for an anonymous reporting mechanism.
For general comments or complaints, including those around quality of care, individuals should continue to use the NCQA Customer Support line (M-F 8:30 - 5:00 ET / 888-275-7585), or submit their information through my.ncqa.org.
The Reporting Hotline should be used for reporting allegations of fraud and other improprieties that could affect NCQA-related operations, including but not limited to the survey process, the HEDIS measures and the determination of NCQA status and level. Individuals may report by phone, e-mail, online or by fax through the Reporting Hotline.
- Toll-Free Telephone:
- English speaking USA and Canada: (844) 440-0077 (not available from Mexico)
- Spanish speaking North America: (800) 216-1288 (from Mexico user must dial 001-800-216-1288)
- E-mail: firstname.lastname@example.org (must include NCQA’s name with your report)
- Fax: (215) 689-3885 (must include NCQA’s name with your report)