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Fraude, malgasto y abuso 

Aetna Better Health® of Ohio is committed to stopping Medicaid fraud, waste and abuse. We look to our members and providers to help. So, if you see fraud, waste or abuse, report it right away.

¿Qué son el fraude, el malgasto y el abuso?

Fraud, waste and abuse are dishonest actions by providers or members.

 

  • Fraud happens when someone lies to get money or services.
  • Waste happens when someone gets benefits or services (for themselves or others) that they aren’t entitled to or don’t need.
  • Abuse happens when someone takes money for services when they haven’t earned payment.

Fraude, malgasto y abuso por parte de proveedores

This includes: 

 

  • Falsifying medical records .

  • Prescribing more medication than is medically necessary.

  • Billing for professional services when a medical professional didn’t perform the service.

  • Giving services that members don’t need.

  • Billing for services or items they didn’t give.

Fraude, malgasto y abuso por parte de miembros

Esto incluye lo siguiente:

 

  • Lending, selling or giving a Medicaid health plan ID card to someone else.
  • Getting medicines or services you don’t need.
  • Forging or changing prescriptions from providers.
  • Getting similar treatments from different doctors. 
  • Going to an emergency room if you know it’s not an emergency.
  • Using someone else’s Social Security number or Medicaid health plan ID number.
  • Receiving money or gifts in exchange for having medical services.

Formas de informar

Formas de informar

Para prevenir, denunciar o impedir el fraude, el malgasto o el abuso, puede llamar a las siguientes entidades:

 

  • Member Services at 1-833-711-0773 (TTY: 711) from 7 a.m. to 8 p.m., Monday through Friday.

También puede completar nuestra forma de fraude, malgasto y abuso.