Fraud and abuse is when a person knowingly cheats or is dishonest, resulting in a benefit such as payment or coverage.

You are encouraged to report matters involving fraud and abuse. If you want to report fraud or abuse, you can remain anonymous. However, sometimes in order to conduct an effective investigation we may need to contact you. Your name will not be shared with anyone who is being investigated. (In rare cases involving legal proceedings, we may have to reveal who you are.)

Examples of Fraud and Abuse

  • An individual does not report all income when applying for Medicaid
  • An individual does not report other insurance when applying for Medicaid
  • A non-recipient uses a recipient’s card with or without the recipient’s knowledge
  • A provider’s credentials are not accurate
  • A provider bills for services that were not rendered
  • A provider performs and bills for services not medically necessary

How to Report Fraud and Abuse

  • Call the Alliance confidential Fraud and Abuse Line at (855) 727-6721.
  • Contact the Division of Medical Assistance by calling the DHHS Customer Service Center at (800) 662-7030.
  • Call the Medicaid Fraud, Waste and Program Abuse Tip Line at (877) DMA‐TIP1 or (877) 362-8471.
  • Call the Health Care Financing Administration Office of Inspector General’s Fraud Line at (800) 447-8477.
  • Call the State Auditor’s Waste Line at (800) 730-TIPS or (800) 730-8477.
  • Complete and submit a Medicaid fraud and abuse confidential online complaint form by going to the DHHS Customer Service website.

You may follow any of the steps listed above or you can call your County Department of Social Services (DSS) office.

Other Resources

Page last modified: July 19, 2018