Nevada Medicaid Fraud, Waste, and Abuse
We work hard to keep healthcare fair and make your experience better. That's why we want to help you understand healthcare fraud and how to report it.
What is fraud, waste, and abuse?
Fraud: Lying or tricking someone to get money or something else you want. It can be things like faking a signature, saying something that's not true to get paid, or sending in fake medical claims. Federal and state laws also explain what is considered fraud.
Waste: Using too much of something without needing to. It's not usually done on purpose. Waste can happen if there aren’t good rules or plans in place. For example, it's wasteful if two doctors order the same lab tests for a patient.
Abuse: Not following the industry standard for ordering medical procedures or billing for them. For example, billing for services that aren't necessary or using the wrong billing code. People can also commit abuse, like ordering too many medical supplies when they aren't really needed.
Two ways to report Medicaid fraud, waste, or abuse
You can report a care provider in the Anthem health plan network or someone with an Anthem Medicaid health plan:
1. Through the Anthem Special Investigations Unit (SIU):
Online form
Report Form - Fraud, Waste, and Abuse
Phone
866-847-8247 (TTY 711)
Special Investigations Unit
740 W. Peachtree St. NW
Atlanta, GA 30308
Or:
2. In your state of Nevada at the Nevada Health and Human Services Surveillance and Utilization Review Unit:
Report a care provider
775-687-8405 (TTY 711)
Report someone who receives Medicaid
Northern Nevada: 775-684-7200 or 775-448-5298 (TTY 711)
Southern Nevada: 702-486-1646 or 702-486-1875 (TTY 711)
You can also make an online report through the Nevada Department of Health and Human Services website.