Reporting Fraud, Waste and Abuse
MHS Health Wisconsin is serious about finding and reporting times that Wisconsin Medicaid funds are used in the wrong way. This is called waste, fraud or abuse.
Fraud means to knowingly get benefits or payments that you are not entitled to receive. Please let us know if you are aware of someone who is committing fraud. This could be a provider or a member. Some examples of health care fraud include:
- A lie on an application
- Using someone else's ID card
- A provider (doctor) billing for services that were not done
- Transportation (usage abuse)
Waste is the overuse of services that may result in costs not needed for health care benefits. This includes direct costs and indirect costs. Waste usually results from the misuse of services.
Abuse is actions that may result in unnecessary costs not needed for health care benefits. This includes direct costs and indirect costs. Abuse involves payment for items or services when there is no legal reason for to pay for them.
If you believe that you are being taken advantage of or hurt by someone, report it. All information will be kept private. Stopping fraud and abuse will help protect you. It will also provide more time and money for your healthcare needs.
There are many ways to report fraud and abuse:
To report waste, abuse, or fraud, gather as much information as possible.
When reporting about a provider (a doctor, dentist, counselor, etc.) include:
- Name, address, and phone number of provider
- Name and address of the facility (hospital, nursing home, home health agency, etc.)
- Medicaid number of the provider and facility, if you have it
- Type of provider (doctor, dentist, therapist, pharmacist, etc.)
- Names and phone numbers of other witnesses who can help in the investigation
- Dates of events
- Summary of what happened
When reporting about someone who gets benefits, include:
- The person’s name
- The person’s date of birth, Social Security Number, or case number if you have it
- The city where the person lives
- Specific details about the waste, abuse, or fraud