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
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.