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 health care costs or losses to the health care system.

Some examples of fraud and abuse by a health care 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

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 health care providers. They can:

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

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