Report Fraud, Waste, and Abuse

Anyone can report fraud, waste, and abuse anonymously relating to Medicaid services.

What are fraud, waste, and abuse?

• Fraud is a false statement from someone who knows the statement is not true.
• Waste is when someone uses a service more than they need to.
• Abuse may not be intentional. Abuse can lead to extra healthcare costs or losses to the healthcare system.

Some examples of fraud and abuse by a healthcare provider are:

• Providing a service that the provider knows won’t be covered. The provider then says a covered service was provided instead.
• Billing or charging you for services that AmeriHealth Caritas Ohio covers
• Offering you gifts or money to get treatment or services you do not need
• Offering you free services, equipment, or supplies in exchange for using your AmeriHealth Caritas Ohio member number
• Giving you treatment or services you do not need

Some examples of fraud and abuse by a member are:

• Members selling their ID cards to other people
• Members lending their ID cards to other people
• Members abusing their benefits by seeking drugs or services that are not medically necessary

You can report suspected fraud, waste, and abuse in any of the following ways:

• Contact the AmeriHealth Caritas Ohio Fraud, Waste, and Abuse Hotline
  • Call: 1-866-833-9718
  • Email: FraudTip@amerihealthcaritas.com
  • Write:
    

    AmeriHealth Caritas Ohio
    Special Investigations Unit
    200 Stevens Drive
    Philadelphia, PA 19113

• Call the Ohio Attorney General’s office at 1-614-466-0722.
• Call the U.S. Office of Inspector General’s Fraud Line at 1-800-HHS-TIPS (1-800-447-8477).
• Visit the U.S. Department of Health and Human Services, Office of Inspector General website at https://oig.hhs.gov/fraud/report-fraud/.

Below are examples of information that will assist with the investigation:

• Contact information (name of individual making the allegation, address, phone number)
• Description of the alleged fraudulent or abuse activities
• Time frame of the allegations
• Name and identification number of the suspected individual
• Source of the complaint, including the type of item or service involved in the allegation
• Approximate dollars involved, if known
• Place of service

Why should I care about fraud, waste, and abuse?

Fraud, waste, and abuse affect both health plan members and healthcare providers. They can:

• Keep you from getting medical services.
• Limit your healthcare benefits.
• Raise your taxes.
• Keep providers from being paid for services.
• Contribute to rising healthcare costs.

Healthcare fraud is a real crime with real consequences. It can lead to fines or even jail time.