MyCare Ohio fraud, waste & abuse

Understand healthcare fraud and how to report it

Healthcare fraud, waste, and abuse affects everyone in the U.S. Let’s make sure you know what it is, how to spot it, and how to help us prevent it. So, what is it exactly?

• Fraud is when someone purposely lies to a health insurance company, Medicaid, or Medicare to get money.
• Waste is when someone overuses health services carelessly.
• Abuse happens when best medical practices aren’t followed, leading to costs and treatments that aren’t needed.

These are some of the ways our investigative team fights scams:

• Reviewing claims and the information in them to spot red flags.
• Keeping a close eye on doctors’ billing patterns for unusual charges.
• Working with other healthcare companies to track suspicious activity.
• Partnering with law enforcement to investigate potential fraud.
• Training all our employees to spot unusual claims.

How can you help?

• Beware of freebies. If you are unsure if a service or extra benefit is for your plan, call the Member Services number on your member ID card.
• Avoid identity theft. Don’t leave your ID card out and let us know if your card is lost or stolen.
• Review your explanation of benefits (EOB). Your EOB is a snapshot of your doctor’s visit. When you review it, make sure the services listed match the services you actually received.

Reporting fraud, waste, or abuse

If you think a member or doctor is involved in fraud, waste or abuse, you should report it.

You can report it in any of the following ways:

• Call the Medicaid Fraud, Waste and Program Abuse Tip Line at 877-DMA-TIP1 (877-362-8471).
• Call the State’s Auditor’s Waste Line at 800-730-TIPS (800-730-8477).
• Call the U.S. Office of Inspector General’s Fraud Line at 800-HHS-TIPS (800-447-8477).
• Call our Special Investigations Unit at 877-660-7890.

Thank you for helping Anthem Blue Cross and Blue Shield My Care’s efforts to find fraud, waste, and abuse.

What to learn more? Visit fighthealthcarefraud.com.