Fraud and abuse
Fraud, abuse and waste are widespread in the health care industry. Sadly, this can cause costs to go up. We are dedicated to fight fraud, abuse and waste through our Fraud Prevention Program. This program is designed to find out and stop health care fraud, abuse and waste.
If you believe you have information relating to health care fraud, abuse and waste, please contact our Special Investigations Unit. The department will review the information provided and will keep everything as confidential as the law permits.
You can report suspected acts of fraud, abuse and waste to Aetna Better Health of Missouri by using our "Fraud, Abuse and Waste Referral Form" below, or by calling our Fraud & Abuse Hotline at 1-866-806-7020 (TTY 711 or TDD 1-800-735-2966), Or
MO HealthNet Division
For Participant Fraud or Abuse
Department of Social Services
Division of Legal Services, Investigation Unit
Send e-mail to MMAC.firstname.lastname@example.org
You may also report suspected acts of fraud, waste or abuse to the Missouri Medicaid Fraud Control Unit, by calling 1-800-286-3932, or sending an e-mail to email@example.com.
The most common types of health care fraud, abuse and waste are:
- Billing for services that were never provided
- Billing for more expensive services than were actually given
- Incorrectly stating a diagnosis to get higher payments
- Performing unnecessary services to get higher payments
- Misrepresenting non-covered procedures as medically necessary
- Selling or sharing a member's identification number for the purpose of filing false claims
Guidelines to follow
Here are a few simple guidelines you can follow to help stop fraud in the health care industry:
- Be careful when providing your health care information. This includes your member identification number. Be cautious of "free" medical treatments where you are asked to provide your health care information
- Understand your benefit plan and what types of treatments, drugs, services, etc., are covered