Members

Fraud and Abuse

Molina Healthcare’s Fraud and Abuse Plan benefits Molina, its employees, members, providers, payers and regulators by increasing efficiency, reducing waste, and improving the quality of services.

Molina Healthcare takes the prevention, detection, and investigation of fraud and abuse seriously, and complies with state and federal laws. Molina Healthcare investigates all suspected cases of fraud and abuse and promptly reports to government agencies when appropriate. Molina Healthcare takes the appropriate disciplinary action, including but not limited to, termination of employment, termination of provider status, and/or termination of membership. You can report potential fraud, waste, and abuse without giving us your name.

To report suspected Medicaid fraud, contact:

Molina Healthcare Alert Line at: Toll free,  866-606-3889

Or

Complete a report form online at: MolinaHealthcare.alertline.com

You may also contact the state to report Medicaid fraud: Toll free, 877-255-3092

Or

Visit the DHHS site Reporting Medicaid Fraud.

Definitions:

“Abuse” means provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in unnecessary cost to the Medicaid program or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program. (42 CFR §455.2)

“Fraud” means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit for them or some other person. It includes any act that constitutes fraud under applicable Federal or State law. (42 CFR § 455.2)

Here are some ways you can help stop fraud:

  • Don’t give your Molina ID card, Medical ID Card, or ID number to anyone other than a health care provider, a clinic, or hospital, and only when receiving care.
  • Never let anyone borrow your Molina ID Card.
  • Never sign a blank insurance form.
  • Be careful about giving out your social security number.