Fraud & Abuse
Fraud, waste and abuse are part of the health care industry and may result in the increase of health care costs. Aetna Better Health of West Virginia is dedicated to fighting fraud, waste and abuse through its Fraud Prevention Program. This program is designed to detect and eliminate health care fraud, waste and abuse.
The most common types of health care fraud, waste and abuse are:
- Billing for services never provided
- Billing for more expensive services than were actually provided
- 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
If you believe you have information relating to health care fraud, waste and abuse, please contact our Fraud Prevention department. The department will review the information and will maintain the highest level of confidentiality as permitted by law.
You can help support our mission to reduce and eliminate fraud in the Health care industry by following a few simple guidelines:
- Be careful when providing your health care information, including your member identification number. Be cautious of “free” medical treatments where you are required to provide them with your health care information
- Aetna Better Health of West Virginia receives bills from your providers to pay. This includes doctor visits, inpatient and outpatient services, and equipment and supplies, etc. There will be times when you receive a letter telling you how we paid for these services. If you receive a letter, please fill it out and return it as soon as possible in the postage paid envelope provided
- Understand your benefit plan and what types of treatments, drugs, services, etc., are covered
Please use this form to report suspected fraud or abuse of services paid for by Aetna Better Health. Complete as much of the requested information below as you can.
Note: Even if you provide your contact information, your identity will be kept confidential.
You can also contact us by phone at 1-844-405-2016 or email us