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What are fraud, waste and abuse?
Fraud, waste and abuse are dishonest actions by providers or members.
- Fraud is when someone lies to get money or services.
- Waste is when someone gets benefits or services (for themselves or others) that they don’t need.
- Abuse is when someone takes money for services when they shouldn’t.
Provider fraud, waste and abuse
This includes:
Making false medical records
Prescribing more medication than is medically necessary
Billing for professional services when a medical professional didn’t perform the service
Giving services that members don’t need
Billing for services or items they didn’t give
Abusing members verbally, physically, mentally or sexually
Member fraud, waste and abuse
This includes:
Lending, selling or giving a health plan ID card to someone else
Getting medicines or services you don’t need
Forging or changing prescriptions from providers
Getting similar treatments from different doctors
Going to an emergency room if you know it’s not an emergency
Using someone else’s Social Security number or member ID number
Receiving money or gifts in exchange for having medical services
How you can help
Our goal is to cut down on fraud in health care. Here are some ways you can help us:
Be careful where you give out your health care info. This includes info like your member ID number.
Watch out for “free” medical care offers. Especially if they ask for your personal health care info.
We get bills from your providers to pay. They could be for doctor visits or other services and supplies. Sometimes you’ll get a letter telling you how we paid for these services and asking you some questions. If you do, be sure to fill it out and return it as soon as possible. Know your benefit plan and what types of treatments, drugs, services and supplies are covered.
Report fraud, waste or abuse
Report fraud, waste or abuse
To prevent, report or stop fraud, waste and abuse, you can:
- Call our fraud hotline at 1-855-415-1558 (TTY: 711)
- Call the state of Florida at 1-888-419-3456
- Email us
Or call Member Services:
- Medicaid Managed Medical Assistance: 1-800-441-5501 (TTY: 711)
- Florida Healthy Kids: 1-844-528-5815 (TTY: 711)
- Long-Term Care: 1-844-645-7371 (TTY: 711)
- Fill out our fraud, waste and abuse form
You have the choice to give your name and info when you make a report. If you do, just know that we keep any info you share with us private.