Report Incident - for National Committee for Quality Assurance (NCQA)

NCQA takes fraud and misconduct seriously. NCQA established its Reporting Hotline to provide both employees and external stakeholders with a secure, anonymous method for reporting suspected incidents of fraud and other misconduct that could affect NCQA-related operations, including, but not limited to reporting of HEDIS measures and determinations of NCQA status for NCQA customers. NCQA does not tolerate retaliation against those who raise concerns in good faith, including its employees, and is committed to protecting the identity of any individual who is alleged to have committed a violation as part of an investigation of a report of fraud or other misconduct.

NCQA Employees are expected to act responsibility and ethically and comply with all applicable laws. The NCQA Code of Conduct is a framework for employees to understand NCQA’s policies and the legal and ethical standards required for our work. Employees and others can report suspected violations or concerns about NCQA’s work or its employees anonymously through the hotline or as described in the Code of Conduct that is available below.

NCQA Customers are required to provide true, accurate and complete information to NCQA. NCQA Customers are NCQA Accredited, Certified or Recognized entities or providers. NCQA does not tolerate fraudulent, misleading or improper information as part of their survey process, measure reporting or for any other NCQA program. Submitting fraudulent, misleading or improper information to NCQA may result in suspension, denial or revocation of NCQA status. Customers and others can report suspected fraud or other misconduct about an NCQA customer through the hotline as described in the External Stakeholder Guidance Document that is available below.

NCQA also accepts written complaints from patients, members or providers related to their care or experience from an NCQA Customer. Please submit your complaint to NCQA Customer Support (M–F 8:30–5:00 ET/888-275-7585), or submit through My.NCQA. NCQA only accepts complaints about an NCQA Accredited, Certified or Recognized entity or provider. To help determine if an entity or provider is NCQA Accredited, Certified, or Recognized please visit: Report Card - NCQA. NCQA Accredited, Certified and Recognized entities and providers must have policies and procedures for resolution of complaints. NCQA can request, on your behalf, that your compliant be handled in accordance with its established policies and procedures. To submit a complaint, you must waive anonymity and provide your contact information for NCQA to obtain authorization to present your complaint to customer, and NCQA a signed Authorization for Disclosure of Health Information if your complaint involves a quality-of-care issues or matters involving your protected health information.

You can find more information about NCQA and reporting suspected fraud or other misconduct through the Reporting Hotline in the documents below: