Reporting Fraud, Waste and Abuse
Louisiana Healthcare Connections is serious about finding and reporting times that Louisiana Medicaid funds are used in the wrong way. This is called waste, fraud or abuse.
“Fraud” means to knowingly get benefits or payments that you are not entitled to receive. Please let us know if you are aware of someone who is committing fraud. This could be a provider or a member. Some examples of healthcare fraud include:
- A lie on an application
- Using someone else’s ID card
- A provider (doctor) billing for services that were not done
- Transportation (usage abuse)
Your health care benefits are given to you based on your eligibility for Medicaid. You must not share your benefits with anyone. If you misuse your benefits, you could lose them. The Louisiana Department of Health may also take legal action against you if you misuse your benefits.
Waste is the overuse of services that may result in costs not needed for health care benefits. This includes direct costs and indirect costs. Waste usually results from the misuse of services.
Abuse is actions that may result in unnecessary costs not needed for health care benefits. This includes direct costs and indirect costs. Abuse involves payment for items or services when there is no legal reason for to pay for them.
Louisiana Healthcare Connections is serious about finding and reporting waste, fraud or abuse. Our staff is available to talk to you about this or you can tell the Louisiana Department of Health (LDH) about it.
To report waste, abuse, or fraud, gather as much information as possible.
When reporting about a provider (a doctor, dentist, counselor, etc.) include:
- Name, address, and phone number of provider
- Name and address of the facility (hospital, nursing home, home health agency, etc.)
- Medicaid number of the provider and facility, if you have it
- Type of provider (doctor, dentist, therapist, pharmacist, etc.)
- Names and phone numbers of other witnesses who can help in the investigation
- Dates of events
- Summary of what happened
When reporting about someone who gets benefits, include:
- The person’s name
- The person’s date of birth, Social Security Number, or case number if you have it
- The city where the person lives
- Specific details about the waste, abuse, or fraud
If you think a provider, member or other person is misusing Medicaid benefits, please tell us right away. Louisiana Healthcare Connections will take your call seriously and you do not need to give your name.