Help Fight Fraud, Waste and Abuse
Medicaid pays doctors, hospitals, pharmacies, clinics and other health care providers to take care of adults and children who need help getting medical care. Sometimes, providers and patients misuse Medicaid resources, leaving less money to help people in our state who need care. This misuse is called fraud, waste and abuse.
Fraud, waste and abuse describe misuse of Medicaid resources. Fraud is purposefully misrepresenting facts. Waste is carelessly or ineffectively using resources. Abuse is excessively or improperly using those resources.
What to look for
Blue Cross Complete works to detect, investigate and prevent health care fraud. You can help by knowing what to look for when you receive health care services.
When you get a bill or statement from your doctor or an Explanation of Benefit Payments statement from us, make sure:
- The name of the doctor is the same doctor who treated you.
- The type and date of service are the same type and date of service you received.
- The diagnosis on your paperwork is the same as what your doctor told you.
- Noncovered items aren't billed as covered items.
Minimizing fraud, waste and abuse means Michigan can provide more care to more people and make the Medicaid program even stronger. Together, all of us can work to find, report and investigate fraud, waste and abuse.
Tell us about fraud
When reporting fraud, waste or abuse, you don't have to leave your name. To make a report, please write:
Blue Cross Complete Anti-fraud Unit
P.O. Box 018
Essington, PA 19029
You may also report or get more information about health care fraud from the Michigan Department of Health and Human Services. Write to:
Office of Health Services Inspector General
P.O. Box 30062
Lansing, MI 48909
Or call toll-free: 1-855-MI-FRAUD (1-855-643-7283)
You may leave information anonymously.
For more information about health care fraud, contact the following organizations:
- National Health Care Anti-Fraud Association
- Centers for Medicare and Medicaid Services
- The Michigan Department of Health and Human Services