NCQA does not tolerate fraudulent, misleading or improper information submitted by organizations as part of their survey process, or any other program.
NCQA defines this information as:
- “Falsified Document.” Documents that have been redrafted, reformatted or fabricated, in whole or in part, with false or misleading information to appear compliant with NCQA standards and guidelines.
- “Fraudulent Information.” Includes oral statements that are false or misleading, made by an applicant or another accredited, certified or recognized person on behalf of the applicant to appear compliant with NCQA standards and guidelines, or any other information intended to otherwise influence the outcome of an NCQA survey.
Submitting any of the above may result in the suspension, denial or revocation of NCQA status.
How to Report Fraud
If you suspect someone submitted a “Falsified Document” or “Fraudulent Information” to NCQA, please call our Reporting Hotline.
NCQA’s confidential Reporting Hotline is set up through Lighthouse Services and available to anyone who wants to report allegations to NCQA.
The Reporting Hotline should be used to report allegations that could affect NCQA-related operations. This includes, but is not limited to, the survey process, HEDIS measures and the determination of NCQA status and level. Individuals may report by phone, email, online or fax.
- English-speaking USA and Canada: 844-440-0077 (not available from Mexico).
- Spanish-speaking North America: 800-216-1288.
Email: email@example.com (must include NCQA’s name with report).
Fax: 215-689-3885 (must include NCQA’s name with report).
For general comments or complaints, including those about quality of care, please contact NCQA Customer Support (M–F 8:30–5:00 ET/888-275-7585), or submit information through My.NCQA.