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Fraud, waste and abuse 

Aetna Better Health® of Maryland is committed to stopping fraud, waste and abuse. We look to our members and providers to help us with this. So if you see fraud, waste or abuse, report it right away.

What are fraud, waste and abuse?

Fraud happens when someone lies to get money or services.

Waste happens when someone uses benefits or services they don’t need.

Abuse happens when someone takes money for services when they aren’t legally entitled to payment.

Provider fraud

Provider fraud, waste and abuse includes: 

 
  • Falsifying medical records 

  • Prescribing more medication than is medically necessary 

  • Giving more health care services than medically necessary 

  • Billing for services that were not rendered  

  • Billing for items not provided 

  • Billing for professional services when a medical professional didn’t perform the service 

  • Committing verbal, physical, mental or sexual abuse

Member fraud 

Member fraud, waste and abuse includes: 

 

  • Lending, selling or giving a health plan ID card to someone else 

  • Getting similar treatments from different doctors 

  • Getting medicines that aren’t necessary 

  • 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 

Who can I call?

Who can I call?

To prevent, report and stop fraud, waste and abuse, you can call: