Report Fraud, Waste, and Abuse

Fraud happens when someone lies or cheats Medicaid on purpose to get a benefit or service they should not have.

Waste is when people use Medicaid resources in the wrong way or too much.

Abuse is when someone causes extra costs for Medicaid.

• Member Examples
• Lying about your income or property to qualify for Medicaid
• Living in another state but still using Maryland Medicaid
• Letting someone else use your member ID or using someone else’s ID to get health services
• Selling or changing a prescription medicine

Provider Examples

• Giving services that the patient did not need
• Charging for services that they did not provide
• Charging for the same service more than once
• Changing medical records to hide fraud

Knowing if something is fraud, waste or abuse depends on the situation, intent, and knowledge. I can be hard to tell the difference between fraud and a mistake. If you are not sure, make a report so the proper agency can investigate it. Not all complaints result in an investigation. Keep in mind that the more information you provide the better.

Reporting will not change how we treat you. You can decide whether you want to give your name or not. Making a report is easy.

Contact Kaiser Permanente’s Ethics and Compliance Hotline

Call 1-888-774-9100 or visit onecompliance.kaiserpermanente.org/hotline/

Contact the Maryland Department of Health, Office of the Inspector General

• Submit a MDH OIG Report Fraud online form: https://health.maryland.gov/oig/Pages/Report_Fraud.aspx
• Call 866-770-7175

Contact the U.S. Department of Health and Human Services, Office of the Inspector General

• Submit a OIG hotline complaint online form: https://oig.hhs.gov/fraud/report-fraud/

• Call 800-447-8477