Health care fraud, waste and abuse
Fraud, waste and abuse increase the cost of health care for everyone. These can also result in improper payments or services that are not medically necessary. Be aware of situations that can expose you to potential fraud, waste and abuse.
Examples of fraud, waste and abuse
- Member alters or forges a prescription
- Member sharing his or her ID card with another person
- Someone else uses your insurance card to obtain health care services
- Member obtains unnecessary equipment and supplies
- Doctor bills for services not performed
- Doctor bills more than once for same service
- Doctor not ordering services that are medically necessary
- Pharmacy bills for drugs or items that you have not received
Be proactive and protect yourself
- Protect your insurance identification card like you would protect your social security number, credit cards or checkbooks
- Don't give your card or number to anyone other than your doctor, clinic, hospital or other Medicaid health care professional
- Don't give you card or number to a stranger who offers you free medical tests or exams
- Avoid using health care providers who say that an item or service is not usually covered, but they know how to bill us to get it paid
- Carefully review explanation of benefits (EOBS) that you receive from us
- Review your claim history to make sure we have not been billed for services you did not receive
What to do if you suspect fraud and abuse
If you think you know of this kind of activity, please contact us in the way that is most convenient for you. You won't have to give your name, address or phone number. Report your concerns through one of the following ways:
Contact Priority Health
- Call Customer Service at 616.464.8102 or 888.975.8102 (TTY users call 711)
Monday - Thursday 7:30 a.m. - 7 p.m., Friday 9 a.m. - 5 p.m., Saturday 8:30 a.m. - noon
- Write or email the Special Investigations Unit (SIU) team:
Priority Health Fraud and Abuse Program MS 3175
1231 E. Beltline NE
Grand Rapids, MI 49525
Call the Compliance Helpline
- Call 800.560.7013 (TTY users call 711). This third-party organization is open 24 hours a day and they'll report your concern to us.
Reporting Medicaid Fraud
Where can I find more information?
Please reference the Member Handbook and Certificate of Coverage for more detailed information.