Report Fraud, Waste, and Abuse

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

Examples of provider fraud and abuse

  • Billing or charging you for services that AmeriHealth Caritas District of Columbia (DC) covers.
  • Offering you gifts or money for treatment or services you do not need.
  • Offering you free services, equipment, or supplies in exchange for using your AmeriHealth Caritas DC enrollee number.
  • Giving you treatment or services you do not need.
  • Physical, mental, or sexual abuse by medical staff.

Examples of enrollee fraud and abuse

  • Enrollees selling their ID cards to other people.
  • Enrollees lending their ID cards to other people.
  • Enrollees abusing their benefits by seeking drugs or services that are not medically necessary.

How to report fraud and abuse

You can report fraud and abuse by calling the AmeriHealth Caritas DC Fraud Tip Hotline at 1-866-833-9718 or to the District of Columbia Health and Social Services (DHSS). If you are not sure it may be fraud and have questions, please call AmeriHealth Caritas DC Customer Service at 1-800-408-7511.

  • To report enrollee or provider fraud and abuse, call toll-free at 1-866-833-9718, Monday through Friday, from 7 a.m. to 6 p.m. You can also call 1-866-833-9718 to report enrollee or provider fraud and abuse anonymously.
  • Report enrollee or provider fraud and abuse online with the U.S. Department of Health and Human Services at the Office of Inspector General. You do not have to give your name, but if you do, the provider or enrollee will not be told you made the report.

Reporting abuse, neglect, and exploitation

AmeriHealth Caritas DC enrollees have the right to be free from abuse, neglect, and exploitation. It is important that you understand how to identify these situations and how to report them.

Abuse can be:

  • Physical
  • Emotional
  • Sexual

It includes pain, injury, mental suffering, being locked up or held in a place against your will, and other cruel treatment.

Neglect can be:

  • When you cannot take care of yourself or get the care you need, placing your life at risk. This is “self-neglect.”
  • When your caregiver is not taking care of your basic needs, putting you at risk for harm to your health or safety. The neglect may be unintended due to the caregiver’s inability to provide or arrange for your care. Neglect may also be due to the caregiver's failure to meet your needs.

Exploitation (if you were made to do something you do not want to do or were asked to do something without knowing the real reason for doing so) can include:

  • Fraud or bullying
  • Forgery
  • Unauthorized use of banking accounts or credit cards

Financial exploitation occurs when a caregiver improperly uses funds intended for your care. These are funds paid to you or the caregiver by a governmental agency.

If you think you or another AmeriHealth Caritas DC enrollee is a victim of these situations, please notify your Clinical Care Coordinator or contact one of the agencies below:

  • Adult Protective Services
    Department of Aging and Community Living
    Call: 202-541-3950
     
  • Child and Family Services
    Call: 202-671-7233
     
  • Complaint and incident reporting for long-term care facilities
    Health Regulation and Licensing Administration — Facility Complaints
    Call: 202-442-5955
    Fill out a complaint form at DC Health.
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