Fraud, Waste, and Abuse

Health care fraud is a crime that has a big impact on the health care system. Both members and health care providers can commit health care fraud.

The cost of fraud, waste, and abuse was more than $3 trillion in 2014, according to the National Health Care Anti-Fraud Association (NHCAA). You can report fraud to AmeriHealth Caritas VIP Care Plus with the secure contact form. Just choose Report fraud, waste, or abuse from the contact form's Subject menu box.

To make an anonymous report, call the Fraud Tip Hotline at 1-866-833-9718, 24 hours a day. You can also mail your tip to the address below. You are not required to provide your personal information. Please include as much detail as you can.

You can also report fraud to the U.S. Department of Health and Human Services at 1-877-7SAFERX (772-3379) or hhstips@oig.hhs.gov.

Why should I care about fraud, waste, and abuse?

Fraud, waste, and abuse affect both health plan members and health care providers. They can:

• Keep you from getting medical services
• Limit your health care benefits
• Keep providers from being paid for services
• Contribute to rising health care costs

In addition, health care fraud is a real crime with real consequences. It could lead to fines or even jail time.

What are fraud, waste, and abuse?

Fraud is a false statement from someone who knows that the statement is false.

• Example: Sam's doctor provides a service to him that he knows won't be covered. Sam's doctor says that he provided a covered service instead.

Waste is when someone uses a service more than they need to.

• Example: Rachel asks two different doctors to give her the same medicine. She now has more medicine than she needs.

Abuse may not be intentional. Abuse can lead to extra health care costs or losses to the health care system.

• Example: Jonathan's doctor sends him to get an X-ray when he does not really need one.

Remember: report health care fraud to the Fraud Tip Hotline at 1-866-833-9718.