Health care fraud is a crime that has a big impact on the health care system. Both members and health care providers can commit health care fraud.

The cost of fraud, waste, and abuse was more than $3 trillion in 2014, according to the National Health Care Anti-Fraud Association (NHCAA). You can report fraud to AmeriHealth Caritas VIP Care with the secure contact form. Just choose Report fraud, waste, or abuse from the contact form's Subject menu box.

To make an anonymous report, call the Fraud Tip Hotline at 1-866-833-9718. You can also mail your tip to the address below. You do not have to provide your personal information. Please include as much detail as you can.

You can also report fraud to the U.S. Department of Health and Human Services at 1-877-7SAFERX (772-3379) or hhstips@oig.hhs.gov.

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

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

• Keep you from getting medical services.
• Limit your health care benefits.
• Keep providers from being paid for services.
• Contribute to rising health care costs.

In addition, health care fraud is a real crime with real consequences. It could lead to fines or even jail time.

What are fraud, waste, and abuse?

Fraud is a false statement from someone who knows that the statement is false.

• Example: Sam's doctor provides a service to him that he knows won't be covered. Sam's doctor says that he provided a covered service instead.

Waste is when someone uses a service more than they need to.

• Example: Rachel asks two different doctors to give her the same medicine. She now has more medicine than she needs.

Abuse may not be intentional. Abuse can lead to extra health care costs or losses to the health care system.

• Example: Jonathan's doctor sends him to get an X-ray when he does not really need one.

Remember: report health care fraud to the Fraud Tip Hotline at 1-866-833-9718.

Examples of provider fraud and abuse

• Billing or charging you for services that AmeriHealth Caritas VIP Care 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 VIP Care member number
• Giving you treatment or services you do not need
• Physical, mental, or sexual abuse by medical staff

Examples of member fraud and abuse

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

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

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

• Keep you from getting medical services
• Limit your health care benefits
• Keep providers from being paid for services
• Contribute to rising health care costs

In addition, health care fraud is a real crime with real consequences. It could lead to fines or even jail time.

Here are some things that will help with the investigation:

• Contact information (e.g., name of person making the report, address, phone number). While this helps, you do not need to provide it if you do not wish to do so.
• Description of the possible fraud or abuse
• Time frame of the possible fraud or abuse
• Name and ID number of the suspected person
• Source of the complaint, including the type of item or service involved in the possible fraud or abuse
• Approximate dollar amounts involved, if known
• Place of service

If you suspect any fraud, waste, or abuse has occurred, do not hesitate to report it. All reports are anonymous. To report member or provider fraud, waste, and abuse:

Phone: Fraud Tip Hotline at 1-866-833-9718, Monday through Friday, 7 a.m. to 6 p.m.

Online:

• U.S. Department of Health and Human Services at the Office of Inspector General
• Our secure contact form

To contact us for any questions, call Member Services at 1-833-433-3767 (TTY 711), April 1 – September 30, 8 a.m. – 8 p.m., Monday through Friday; or October 1 – March 31, 8 a.m. – 8 p.m., seven days a week

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