Fraud and Abuse
Molina Healthcare’s MississippiCAN Fraud, Waste and Abuse Plan benefits Molina, its employees, members, providers, payors and regulators by increasing efficiency, reducing waste, and improving the quality of services. Molina Healthcare takes the prevention, detection, and investigation of fraud, waste and abuse seriously, and complies with state and federal laws. Molina Healthcare investigates all suspected cases of fraud, waste and abuse and promptly reports all confirmed incidences to the appropriate government agencies. Molina Healthcare takes the appropriate disciplinary action, including but not limited to, termination of employment, termination of provider status, and/or termination of membership.
You can report potential fraud, waste and abuse without giving us your name. To report suspected Medicaid fraud, contact Molina Healthcare AlertLine at:
Toll free: (866) 606-3889
or
Complete a report form online at:
https://molinahealthcare.alertline.com
You may also send your concerns by mail to:
Attention: Compliance Officer
(CONFIDENTIAL)
Molina Healthcare of Mississippi, Inc.
1020 Highland Colony Parkway, Suite 602
Ridgeland, MS 39157
Fax: (CONFIDENTIAL) Attention Compliance: (844) 808-2407
You can also report to the state: To report suspected Medicaid fraud and/or abuse in Mississippi, call Mississippi Attorney General’s Medicaid Fraud Control Unit toll free 1-800-852-8341 or email:
or you may also:
Call the Office of the Medicaid Inspector General (OMIG) Fraud Hotline toll free: 1 (877) 87FRAUD or 1 (877) 873-7283
If you report suspected fraud and your report results in a fine, penalty or forfeiture of property from a doctor or other health care provider, you may be eligible for a reward. You can talk to the Attorney General’s Office about keeping your identity confidential and protected. For more information, contact the Mississippi State Attorney General office toll free, 1 (800) 852-8341.
Definitions:
“Abuse” means provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in unnecessary cost to the Medicaid program or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program. (42 CFR §455.2)
“Fraud” means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable Federal or State law. (42 CFR § 455.2)
“Waste” means health care spending that can be eliminated without reducing the quality of care. Quality Waste includes, overuse, underuse, and ineffective use. Inefficiency Waste includes redundancy, delays, and unnecessary process complexity. For example: the attempt to obtain reimbursement for items or services where there was no intent to deceive or misrepresent, however the outcome of poor or inefficient billing methods (e.g. coding) causes unnecessary costs to the Medicaid programs.
Here are some ways you can help stop fraud:
- Do not give your Molina Healthcare ID card, Medical ID Card, or ID number to anyone other than a health care provider, a clinic, or hospital, and only when receiving care.
- Never let anyone borrow your Molina Healthcare ID Card.
- Never sign a blank insurance form.
- Be careful about giving out your social security number.