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What are fraud, waste and abuse?
Fraud, waste and abuse are dishonest actions by providers or members.
- Fraud happens when someone lies to get money or services.
- Waste happens when someone gets benefits or services (for themselves or others) that they aren’t entitled to or don’t need.
- Abuse happens when someone takes money for services when they haven’t earned payment.
Provider fraud, waste and abuse
Provider fraud, waste and abuse
This includes:
Falsifying 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 can you report fraud, waste and abuse?
To prevent, report or stop fraud, waste and abuse, you can contact us or the state.
If you'd like to report fraud, waste and abuse, you can call any one of our helplines:
- Member Services: 1-866‑-316‑3784 (TTY: 711)
- Provider Relations: 1-866-316-3784 (TTY: 711)
- Special Investigations Unit: 1-866-806-7020 (TTY: 711)
To report fraud, waste and abuse, you can also contact the Office of Inspector General (OIG).
You have a few options:
- Submit an online complaint form.
- Email the OIG.
- Call the OIG at 1-855-MI-FRAUD (1-855-643-7283). You can call Monday through Friday, 8 AM to 5 PM. And you can leave a voicemail outside of those hours.
- Send the OIG a letter to their address:
- Office of Inspector General
PO Box 30062
Lansing, MI 48909
- Office of Inspector General
You can also fill out our fraud, waste and abuse form.