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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
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.
Member fraud, waste and abuse
- Lending, selling or giving a Medicaid 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 Medicaid health plan ID number.
- Receiving money or gifts in exchange for having medical services.