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UMPQUA HEALTH PROVIDERS

Reporting Fraud, Waste, and Abuse (FWA)

Protecting Integrity Across Our Network

At Umpqua Health, integrity, accountability, and transparency are core values. We are committed to preventing and addressing fraud, waste, and abuse (FWA) and other forms of misconduct throughout the healthcare system.

Whether you are a provider, employee, patient, or member of the public—your voice matters. Reporting suspected misconduct helps protect public resources and ensures members receive high-quality, ethical care.

What Is Fraud, Waste, and Abuse?

Understanding the difference between fraud, waste, and abuse helps ensure effective and timely reporting:

Fraud

Intentional deception or misrepresentation made for personal gain or to receive unauthorized benefits.

Examples:

  • Billing for services not rendered
  • Altering medical records or claims
  • Using another person’s Medicaid ID

Waste

Overutilization or careless use of healthcare resources that results in unnecessary costs.

Examples:

  • Ordering duplicative or excessive tests
  • Failing to coordinate care

Abuse

Practices that result in unnecessary costs, improper payments, or services outside of accepted standards—even without intent to deceive.

Examples:

  • Upcoding or billing for a higher level of service than was performed
  • Providing services that aren’t medically necessary

Your Role as a Provider

As a trusted partner in our provider network, you are expected to:

  • Follow ethical billing and documentation practices
  • Train your staff on FWA awareness and reporting procedures
  • Promptly report suspected misconduct
  • Cooperate with audits or investigations when needed

Reporting suspected FWA is both a professional obligation and a regulatory requirement.

UHA Encourages All Reports of Misconduct

Umpqua Health encourages providers, patients, employees, and members of the public to report any behavior that may be:

  • Illegal
  • Unethical
  • Fraudulent
  • Wasteful or abusive
  • Violating UHA’s Code of Conduct or compliance policies

How to File a Report

You can report anonymously or confidentially through multiple channels:

Reporting Details

Please include as much information as possible to support the review process:

  • Name of the person, provider, or organization involved
  • Dates or timeframes of the activity
  • Description of the concern or misconduct
  • Any related documents or examples

After you file your report (online or by phone), you will receive a report number. Use this number to:

  • Add more details later
  • Ask about the status of your report
  • Remain anonymous while staying involved in the process

Confidentiality & Non-Retaliation

Umpqua Health strictly prohibits retaliation of any kind against anyone who reports or helps investigate suspected misconduct in good faith. All reports are handled with discretion and confidentiality in accordance with applicable laws.

Employment-related complaints are forwarded to UHA’s Human Resources Department. All other reports go directly to the Compliance Officer.

Additional Resources for Providers

For more information, please review the following documents from our Compliance Program:

Code of Conduct

Our Code of Conduct serves as a guide for all employees and partners to maintain ethics and compliance standards.

Compliance Program Manual

This manual governs Umpqua Health’s Compliance programs and practices.

Fraud, Waste and Abuse (FWA) Prevention Handbook

This handbook governs Umpqua Health’s FWA Prevention programs and practices.

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Thank You for Supporting Ethical Healthcare

We appreciate your partnership in upholding our values of integrity and accountability. If you have any questions, our Compliance team is here to help.