Report Fraud, Waste, and Abuse

Unfortunately, there may be times when you see fraud or abuse relating to Medicaid services.

Examples of provider fraud and abuse

  • Billing or charging you for services that AmeriHealth Caritas Florida covers.
  • Offering you gifts or money to get treatment or services you do not need.
  • Offering you free services, equipment, or supplies in exchange for using your AmeriHealth Caritas Florida member ID number.
  • Giving you treatment or services you do not need.
  • Physical, mental, or sexual abuse by medical staff.

Examples of member fraud and abuse

  • Members selling their ID cards to other people.
  • Members lending their ID cards to other people.
  • Members abusing their benefits by seeking drugs or services that are not medically necessary.

How to report fraud and abuse

You can report fraud and abuse by calling the AmeriHealth Caritas Florida Hotline number at 1-866-833-9718. You can also report fraud and abuse to Florida Consumer Complaint Hotline at 1-888-419-3456. If you are not sure it may be fraud and have questions, please call AmeriHealth Caritas Florida Member Services 1-855-355-9800.

  • To report member or provider fraud and abuse, call toll free at 1-866-833-9718, Monday to Friday, 7 a.m. to 6 p.m. ET. This call may be anonymous, you do not have to give your name.
  • Report member or provider fraud and abuse online with the U.S. Department of Health and Human Services at the Office of Inspector General: https://oig.hhs.gov/fraud/report-fraud/. You do not have to give your name, but if you do, the provider or member will not be told it was you who made the report.

Reporting abuse, neglect, and exploitation

AmeriHealth Caritas Florida members have the right to be free from abuse, neglect, and exploitation. It is important that you understand how to identify these situations and how to report them.

Abuse can be:

  • Physical
  • Emotional
  • Sexual

Abuse includes pain, injury, mental suffering, being locked up or held in a place against your will, and other cruel treatment.

Neglect can be:

  • When you cannot take care of yourself or get the care your need, placing your life at risk. This is “self-neglect.”
  • When your caregiver is not taking care of your basic needs, putting you at risk for harm to your health or safety. The neglect may be unintended due to the caregiver’s inability to provide or arrange for your care. Neglect also may be due to the carelessness of the caregiver to meet your needs.

Exploitation (if you were made to do something you do not want to do or were asked to do something without knowing the real reason for doing so) can include:

  • Fraud or bullying
  • Forgery
  • Unauthorized use of banking accounts or credit cards

Financial exploitation occurs when a caregiver improperly uses funds intended for your care. These are funds paid to you or the caregiver by a governmental agency.

If you think you or another AmeriHealth Caritas Florida member is a victim of these situations, please notify your Care Manager/Care Coordinator or contact one of the agencies below:

Members