Reporting Waste, Fraud and Abuse

Medicaid Fraud Notice 10/23/2017 

Medicaid Fraud Notice 

 

How do I report someone who is misusing the CHIP or Medicaid program?

If you suspect a person who receives CHIP or Medicaid benefits or a Provider (doctor, dentist, counselor, etc.) has committed waste, abuse or fraud, you have a responsibility and a right to report it.

Reporting Waste, Abuse or Fraud by a Provider or Member

You can report any Providers or Members you suspect of waste, abuse, or fraud in several ways.

To report waste, abuse or fraud, gather as much information as possible

When reporting a Provider (doctor, dentist, counselor, etc.), include:

  • Name, address, and phone number of Provider
  • Name and address of the facility (hospital, nursing home, home health agency, etc.)
  • Medicaid number of the Provider and facility, if you have it
  • Type of Provider (doctor, dentist, therapist, pharmacist, etc.)
  • Names and phone numbers of other witnesses who can help in the investigation
  • Dates of events
  • Summary of what happened

When reporting about someone who receives benefits include:

  • The person’s name
  • The person’s date of birth, Social Security Number, or case number if you have it
  • The city where the person lives
  • Specific details about the waste, abuse or fraud