Unfortunately, there could be a time when you see fraud or abuse related to Plan Vital. Some examples are:
- A person lies about facts to get or keep Plan Vital coverage
- A doctor bills you or makes you pay cash for covered services
- A person uses someone else’s Member card
- A doctor bills for services that you did not get
- A person sells or gives medications to someone else
If you find out about fraud or abuse, you must tell us about it. You can call Triple-S Salud, the Patient’s Advocate Office or ASES. You do not need to tell us your name and we will keep your information private. You will not lose your Plan Vital coverage if you report fraud or abuse.
If you want more information, you can visit the ASES website at www.planvitalpr.com On the website there is a formulary that you can use to make your report.
You can also help prevent fraud and abuse. Here are some things you can do:
- Don’t give your Plan Vital Member Card to anyone else.
- Learn about your Plan Vital benefits.
- Keep records of your doctor’s visits, laboratory tests and drugs. Make sure you don’t get repeat services.
- Make sure your information is right on a form before you sign it.
- Request and review the quarterly summary of the services you receive. You may request the summary of services directly from Triple-S Salud.