What is healthcare fraud, waste and abuse?
Healthcare fraud and abuse occurs in every area of healthcare. Healthcare fraud is the intentional falsification of a fact on a healthcare claim in order to receive payment or services not owed to them. Healthcare waste and abuse describes practices that directly or indirectly result in unnecessary costs to a healthcare program and its members.
Who commits healthcare fraud, waste or abuse?
Providers can commit healthcare fraud, waste or abuse by:
- Billing incorrectly
- Billing for: services never rendered, inappropriate/unnecessary services, or “free services”
- Make false claims about qualifications, licensure and/or education
- Falsify records to suggest ongoing medical services
- Forge a physician’s signature on plans of care
- Alter information on care plans, prescriptions, and/ or other medical documentation
- Billing for multiple family members when only one family member received service(s) and/or supplies
- Change or incorrectly code a claim to receive maximum payment
- Falsify the diagnosis or procedure to maximize payments
- Change dates of service for double billingIf it sounds too good to be true, it probably is.
Patients can commit healthcare fraud, waste and abuse by:
- Share health plan ID cards
- Claim non-covered dependents
- Participate in doctor shopping (“Doctor Shopping” is a term commonly used to refer to a patient who may or may not have a real physical illness, but goes from doctor to doctor with the objective of improperly obtaining multiple prescriptions for narcotic painkillers)
- Consent with doctors to submit claims for services not received or not necessary
- Fabricate claims
- Alter submitted medical documentation of any type
- Use a stolen health plan ID card to obtain healthcare services
- Use a deceased member’s health plan ID card to obtain healthcare services
- Ineligible persons using an eligible person’s health plan ID card to obtain medical services or benefits
How can I help stop healthcare fraud?
Healthcare fraud takes money from healthcare programs and leaves less money for real medical care.
Here are some ways you can help stop fraud:
- Do not give your Molina Healthcare ID Card, DSHS Medical ID Card or ID number to anyone other than a healthcare provider, a clinic, or hospital and only when receiving care
- Do not let anyone borrow your Molina Healthcare ID Card or DSHS Medical ID Card
- Do not sign a blank insurance form
- Be careful about giving out your Social Security number
- Be careful of anyone who offers you "free" tests and services in exchange for your Medical/Molina Healthcare card number.
You can report fraud by:
You can report fraud, without giving us your name, by:
- Phone: Toll-free (866) 702-0404 (Confidential Compliance Voicemail Box)
- Fax: Compliance Director (425) 424-7156 or toll free (800) 282-9929
Attn: Compliance Director (CONFIDENTIAL)
Molina Healthcare of Washington
PO Box 4004
Bothell, WA 98041-4004
- Email: email@example.com
If you think fraud has taken place, call DSHS at:
- (800) 562-6906 to report Medicaid client fraud
- (360) 586-8888 to report Medicaid provider fraud
Additional Health Care Compliance and Anti-Fraud & Abuse Information may be accessed by visiting any of the following websites:
Office of the Attorney General
Washington State Medicaid Fraud Control Unit
P.O. Box 40116
Olympia, WA 98504-0116
Tel. (360) 586-8888
Fax (360) 586-8877
Division of Fraud Investigations at DSHS at
For those who do not have access to computers in your home, Internet access is available at your local public library.
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