Learn about fraud and abuse
Molina Healthcare is committed to stopping fraud, reducing waste, and improving the quality of service.
Overview
Molina Healthcare works hard to stop fraud, waste, and abuse. This helps protect your health care and makes sure services are used the right way.
Fraud, waste, and abuse can hurt members and raise health care costs. Molina follows all state and federal laws and takes these issues very seriously.
Molina looks at each report of fraud, waste, or abuse. If we find a real problem, we report it to the right government office. We also take action. This could be ending someone’s job, ending a provider’s contract, or ending a member’s plan.
You can report fraud, waste, or abuse at any time. You do not have to give your name..
How to file a report
If you think there is fraud, waste, or abuse, you can tell Molina Healthcare. You can choose to give your name or report it without your name.
When you report a concern, please share as many facts as you can. This helps us look into the issue.
Try to include:
· What happened
· The name of the person or place involved
· Their phone number, address, or any ID numbers, if you have them
You can report fraud, waste, and abuse to Molina Healthcare in any of these ways:
Telephone
Call the Toll-Free number of the Molina Healthcare Anti-Fraud Line: (866) 606-3889 TTY:711 24 hours a day, 7 days a week
Online
Report an issue online through a confidential and secure site, visit: https://MolinaHealthcare.AlertLine.com
You may report fraud, waste, and abuse to the United States Health and Human Services Office of Inspector General at:
Office of the Inspector General P.O. Box 23489 Washington D.C., 20026 HHS TIPS Fraud Hotline: (800) HHS-TIPS TTY: 711 http://www.oig.hhs.gov/
Key terms and definitions
Abuse
Abuse happens when a provider or member does something that is not good practice and causes extra or unnecessary costs. This may include billing for care that is not needed or not meeting proper care standards. (42 CFR §455.2).
Fraud
Fraud is when someone lies or gives false information on purpose to get a service or payment they should not get. This includes any act that counts as fraud under state or federal law. (42 CFR § 455.2).
Waste
Waste means money spent on health care that is not needed. This can happen when services are used too much, too little, or in the wrong way. It can also happen when billing mistakes cause extra costs, even if no one meant to deceive any person.
How can you help stop fraud:
· Show your Molina Healthcare ID card only when getting care from a doctor, clinic or hospital
· Do not let any person borrow your ID card
· Do not sign any insurance form that is blank
· Be careful when sharing your Social Security number. Only give it when it is needed