Members

Fraud, Waste and Abuse

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Molina Healthcare of Utah's Medicaid Fraud, Waste and Abuse Plan benefits Molina, its employees, members, providers, payors and regulators by increasing efficiency, reducing waste, and improving the quality of services. Molina takes the prevention, detection, and investigation of fraud, waste and abuse seriously, and complies with state and federal laws. Molina investigates all suspected cases of fraud, waste and abuse and promptly reports all confirmed incidences to the appropriate government agencies. Molina 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's AlertLine at:

Toll free: (866) 606-3889

or

Complete a report form online at:

https://www.molinahealthcare.alertline.com/

You may also send your concerns by mail to:

Attention: Compliance Officer
(CONFIDENTIAL)
Molina Healthcare of Utah
7050 S. Union Park Center, Suite 200
Midvale, UT 84047

You can also report to the State of Utah:

  • Call the Utah Department of Health Care Services Anti-Fraud Line: (800) 662-9651.
  • Call the Utah Office of the Inspector General: (855) 403-7283.

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 to himself or some other person. It includes any act that constitutes fraud under applicable Federal or State law. (42 CFR 455.2)

“Waste” means health care spending that can be eliminated without reducing the quality of care. Quality Waste includes overuse, underuse, and ineffective use. Inefficiency Waste includes redundancy, delays, and unnecessary process complexity. For example: the attempt to obtain reimbursement for items or services where there was no intent to deceive or misrepresent, however the outcome of poor or inefficient billing methods (e.g. coding) causes unnecessary costs to the Medicaid programs.

Here are some ways you can help stop fraud:

  • Do not give your Molina member ID card, Utah Medicaid 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 Medicaid ID cards.
  • Never sign a blank insurance form.
  • Be careful about giving out your social security number.