Fraud, Waste, and Abuse

What is fraud, waste, and abuse and why does it matter?

We take the detection, investigation, and prosecution of fraud, waste and abuse very seriously.

Fraud is when someone knowingly and intentionally executes or attempts to execute a scheme to obtain money or property of any healthcare benefit program.
Waste is providing services that are not medically necessary
Abuse is when healthcare providers or suppliers perform actions that directly or indirectly result in the unnecessary cost to the healthcare benefit program.

Examples of fraud, waste or abuse include:

Inappropriate billing by a provider (tooltip: such as billing for a more expensive service than the patient received, submitting multiple claims or bills for the same service)
Providing or billing for services without a license
Provider billing for services you did not receive
Conducting more visits that medically necessary
Using someone else’s ID card to receive medical services

If you suspect fraud, waste or abuse, you can report your concern. We appreciate your vigilance and courage in this matter.