Fraud, Waste and Abuse
If you have concerns about possible fraud, waste and abuse, you can report your concerns by calling the Molina AlertLine to report fraud, waste and/or abuse. If you have questions about customer service issues (e.g. a claim not paid on time or the incorrect amount paid), call the [Molina Complete Care Corporate Compliance Hotline].
You can also report fraud by filling out the fraud, waste and abuse form online. Please give as much information as possible. You do not have to give your name. AHCCCS will not share your information with the provider.
Confidential hotline numbers (available 24 hours a day, 7 days a week):
AlertLine: (866) 606-3889
Molina Complete Care Special Investigation Unit: (877) 269-7624
You can also report fraud, waste or abuse concerns directly to the Arizona Health Care Cost Containment System (AHCCCS)/Office of Inspector General (OIG) at:
Office of the Inspector General
701 E Jefferson St, MD 4500
Phoenix, AZ 85034
Phone: (602) 417-4193 (within Maricopa County)
(888) ITS-NOT-OK (487-6686) (outside Maricopa County)
Health care fraud, waste and abuse prevention tips
You can help us stop fraud, waste or abuse by doing these things:
- Review your paperwork from your plan, such as your Explanation of Benefits or Service Verification surveys (if received). Make sure the following information is correct:
- Date of service
- Type(s) of service(s) reported
- Name of the provider billing for those services
- Protect your insurance card and personal information at all times. Do not share it with others.
- Count your pills when picking up a prescription.
- Report anything that seems wrong to Molina Complete Care as soon as possible.
Examples of fraud, waste and abuse:
Provider fraud, waste and abuse can include any and/or all of the following:
- Providing medical services that are not needed
- “Up-coding” – charging for a more complex or expensive service than was given
- Billing for services that were not provided
- Lying about a patient’s diagnosis so they can get tests, surgeries or other procedures that aren’t needed
- Billing for rented medical equipment after it has been returned
- Billing twice for the same service
- Billing for more services than can be performed in one day
- Asking for, offering or getting money or something of value in exchange for referrals (e.g. a doctor paying a patient to refer other Medicaid members, or to get services that are not needed)
Member fraud, waste and abuse can include any and/or all of the following:
- Using another person’s name to get Medicaid services
- Sharing a member ID card or using another person’s member ID card
- Visiting several doctors to get multiple prescriptions
- Lying to a care coordinator or someone else to try and get a service you don’t need
- Paying a doctor cash for a prescription that is not needed
- Making false documents by changing:
- The date of service
- Medical records
- Referral forms