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Fraud, waste and abuse

There are many different types of fraud, waste and abuse. Health care fraud affects all of us. It impacts the quality of health care. It also results in higher costs. We want to know if someone is taking advantage of you or our services. If you have any questions about reporting fraud, waste or abuse, you can call Aetna Assure Premier Plus (HMO D-SNP) at 1-855-282-8272 (TTY: 711).

Member fraud, waste and abuse

Member fraud, waste and abuse

Committing fraud, waste or abuse is a crime. You can face serious consequences for committing these acts. You must pay back any money given to you for services. You may be prosecuted for a crime and go to jail. You could also lose your Aetna Assure Premier Plus (HMO D-SNP) coverage for up to a year. Member fraud, waste and abuse can be: 

 

  • Lying or holding back information when you sign up to be a member of Aetna Assure Premier Plus (HMO D-SNP) 

  • Letting someone else use your Aetna Assure Premier Plus (HMO D-SNP) ID card 

  • Not telling Aetna Assure Premier Plus (HMO D-SNP) that you have other insurance 

Provider fraud, waste and abuse

Provider fraud, waste and abuse

Examples of provider fraud, waste and abuse include: 

  • 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 did not perform the service


Who do I send my report to?

If you suspect fraud, waste or abuse related to your coverage, you can:

File online

You can fill out our online fraud, waste and abuse form here.

File now

Call us

You can call our Fraud, Waste and Abuse Hotline at 1‑855‑282‑8272 (TTY: 711).

Call the state

You can report suspected cases of fraud, waste and abuse to the state of New Jersey at 1-888-937-2835 or 1-888-692-2140.