Fraud & abuse

Medicaid fraud can be:

  • Lying or holding back information when you sign up to be a member of Virginia Medicaid or FAMIS
  • Letting someone else use your Aetna Better Health Member ID card
  • Not telling the Social Security Administration (SSA) or the Department for Community Based Services (DCBS) about changes in income and family status
  • Not telling Virginia Medicaid that you have other insurance

Medicaid abuse can be:

  • Too many emergency room visits for conditions that are not emergencies
  • Using pain medicines that you do not need
  • Getting prescriptions that you do not need

If you commit Medicaid fraud, you:

  • Must pay back any money Medicaid paid for you to get services
  • Could be prosecuted for a crime and go to jail
  • Could lose your Virginia Medicaid benefits for up to a year

Providers can commit fraud many different ways. Provider fraud, like member fraud, takes money from those who need it. Because of this fraud, there is less money to treat members who need medical help. You can help stop provider fraud.

Keep a record of:

  • Medical services you get
  • When and where the service takes place
  • Name of the person who takes care of you
  • Any other services ordered by the provider

Some examples of provider fraud are:

  • Billing for services that you did not get
  • Making an appointment for a return office visit when you do not need one
  • Taking x‑rays, doing blood work, etc. that you do not need
  • Billing for services that someone else in the office actually performed (charging you too much for those services)
  • Billing for more time than the service took
  • Adding extra names to your bill (for example, a family member) and billing for those
  • Taking money from another provider to refer you to him/her

If you think someone has committed Medicaid fraud or abuse, call Medicaid’s Fraud and Abuse Hotline at 1‑800‑372‑2970. Everything you say is private.

* 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.