Fraud & Abuse

Protect yourself from scams and identity theft

Health care fraud affects all of us. It impacts the quality of health care. Aetna Better Health of Illinois is dedicated to fight fraud, abuse and waste through its Fraud Prevention Program. This program is designed to detect and eliminate health care fraud, abuse and waste.

What can you do?

Know what to look for. It can help you protect your identity and benefits. Be suspicious of:

  • People trying to sell you health care items or services door-to-door or over the phone
  • People who offer money or gifts for health care services
  • Bills for services or equipment you didn't get
  • Shipments of medical supplies you didn't order
  • Someone using your ID card to get medical care, supplies or equipment
  • People offering you free gifts or services in exchange for your ID number
  • Falsifying timesheets for services not provided or only partially provided
  • Incorrectly stating a diagnosis to get higher payments
  • Performing unnecessary services to get higher payments

Know Who You're Sharing Information With

Don't be afraid to ask questions if someone asks for your personal information. Never give out your Social Security number, health plan numbers, or banking information to anyone you don't know.

It’s important to be able to identify these issues and protect your identity and benefits.  

Online theft of personal Information

People may try to steal your personal or Medicare-Medicaid information online. They can harm you financially and may disrupt your benefits. It’s not always easy to distinguish an important email about your benefits from an online scam. An email may say there’s a problem with your account or ask for updated information to continue your coverage.

You can help support our mission to reduce and eliminate fraud in the health care industry by following a few simple guidelines:

  • Be careful when providing your health care information, including your member identification number. Be cautious of "free" medical treatments where you are required to provide them with your health care information.
  • Understand your benefit plan and what types of treatments, drugs, services, etc., are covered.

Telemarketing Scams

Many legitimate businesses use telemarketing. But criminals can also use live or recorded calls to try to steal your identity. Aetna won't call to ask for your bank account number, Social Security number, ID number or health plan ID number.

What you can do:

  • Hang up on recorded messages that ask you to verify your personal information.
  • Don't press any keys or numbers when prompted - even if it's to take your name off their list.
  • Never give your personal information to someone you don't know.

Online Pharmacy Scams

Most online pharmacies aren't safe or legal. They might send you medicine that is tampered with, expired, or fake. They could use your personal information to steal your identity.

What you can do:

  • Only order from online pharmacies in your health plan's pharmacy network.
  • Don't click on links in emails or pop-up advertisements on the internet.
  • Don't order from pharmacies outside of the United States.
  • Report pharmacies that...
    • Offer prescription drugs without a prescription.
    • Won't accept your prescription insurance card as a form of payment.

Lab Test Fraud

Your doctor must order genetic tests for Aetna to cover them. Some labs try to offer a free test in order to get your Aetna information. They may try to steal your identity or submit a fraudulent bill.

What to do before you agree to genetic testing:

  • Make sure your doctor ordered the test.
  • Make sure the test is medically necessary and that we cover it.

If you see something suspicious or have a question about your plan statement, call Member Services

Medicaid Member Services at 1-866-212-2851 (TTY 711)

Medicaid-Medicare Services at 1-866-600-2139 (TTY 711)

MLTSS Member Services at 1-855-849-3201 (TTY 711)

You can also report your concerns to us anonymously using our online form below.

* Required Fields

Fraud and Abuse Reporting Form

Optional information: You don’t need to give us your name or contact information. But if you do, we’ll keep it confidential. You can also choose to give us just your contact information and not your name.

If you choose not to give your contact information, our review will be only about the information you’re reporting. It’s important that you give us as much information as you can. It will help us do a complete and correct investigation.