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Report Fraud, Waste and Abuse

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

If you suspect that someone is committing Medicaid fraud, report it. Examples of Medicaid fraud include:

  • An individual who does not report all income or other health insurance when applying for Medicaid.
  • An individual who does not get Medicaid uses a Medicaid member's card with or without the member's permission.
  • A health provider or a clinic bills for services that were not provided or were not medically necessary.

You can report suspected fraud and abuse in any of the following ways:

  • Call the AmeriHealth Caritas North Carolina Fraud, Waste and Abuse Hotline at 1-866-833-9718 or email FraudTip@amerihealthcaritas.com.
  • Call the Medicaid Fraud, Waste and Program Abuse Tip Line at 1-877-DMA-TIP1 (1-877-362-8471).
  • Call the State Auditor's Waste Line at 1-800-730-TIPS (1-800-730-8477).
  • Call the U.S. Office of Inspector General's Fraud Line at 1-800-HHS-TIPS (1-800-447-8477).

Below are examples of information that will assist with the investigation:

  • Contact Information (e.g., name of individual making the allegation, address, phone number – this information is optional, you can remain anonymous).
  • Description of the alleged fraudulent or abuse activities.
  • Time frame of the allegation(s).
  • Name and identification number of the suspected individual.
  • Source of the complaint, including the type of item or service involved in the allegation.
  • Approximate dollar amounts involved, if known.
  • Place of service.