Magellan Complete Care of Florida

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Fraud, Waste & Abuse

Reporting Abuse, Neglect, Exploitation or Compliance concerns.  You can report abuse, neglect, or exploitation by calling the abuse hotline at 800-96-ABUSE. 

Report fraud, waste, abuse, overpayments, or other compliance issues.

Definition of Fraud, Waste, and Abuse

  • Fraud refers to a false action that is used to gain something of value
  • Waste is the misuse of services
  • Abuse refers to overused or unneeded services

Magellan Complete Care is dedicated to conducting business in a legal manner. We are committed to preventing, detecting and reporting fraud, waste and abuse. In addition, the Bureau of Medicaid Program Integrity wants to prevent fraud, waste and abuse. They check on anybody including members, providers, and vendors who may be trying to commit fraud, waste or abuse against the Medicaid Program. They also: 

  • Recover overpayments
  • Issue warnings
  • Send possible fraud cases for investigation

Examples of Fraud, Waste and Abuse:

  • Medical services that are not needed
  • Billing for services that were not provided
  • Billing for services not covered by Medicaid
  • Billing twice for the same service
  • Using a billing code to get extra payments
  • Using another person's identity to get Medicaid services
  • Making false documents by changing:
    • The date of service for a claim
    • Prescriptions
    • Medical records
    • Referral forms
  •  Paying or taking a bribe

If you think someone or a provider is committing fraud, waste and abuse, please report it. The Magellan Complete Care Corporate Compliance hotline is available 24 hours a day, seven days a week. An outside company handles the line, and callers do not have to give their names. All calls will be investigated and will remain confidential.

  • Corporate Compliance Hotline: 800-915-2108
  • Compliance Unit Email: Compliance@MagellanHealth.com
  • You can also contact Magellan's Special Investigations Unit at 800-755-0850 or SIU@MagellanHealth.com.

To report suspected fraud or abuse in Florida Medicaid call the consumer Complaint Hotline toll-free at 888-419-3456 or complete a Medicaid Fraud and Abuse Complaint Form, which is available online at https://apps.ahca.myflorida.com/inspectorGeneral/fraud_complaintform.aspx

If you report suspected fraud and your report results in a fine, penalty or forfeiture of property from a doctor or other health care provider, you may be eligible for a reward through the Attorney General’s Fraud Rewards Program, toll-free 866-966-7226 or 850-414-3990.

The reward may be up to twenty-five percent (25%) of the amount recovered, or a maximum of $500,000 per case (Section 409.9203, Florida Statutes).

You can talk to the Attorney General’s Office about keeping your identity confidential and protected. You can report suspected fraud, waste, and abuse to the Florida Department of Financial Services Division of Insurance Fraud: Contact the DFS Fraud Hotline at 1-800- 378-0445.

You can also contact the U.S. Department of Health & Human Services Office of Inspector General at 1-800-447-8477 or by e-mail to HHSTips@oig.hhs.gov or by mail to the address below.

U.S. Department of Health and Human Services
Office of Inspector General
ATTN: OIG HOTLINE OPERATIONS
PO Box 23489
Washington, DC 20026

More information is available at:

http://ahca.myflorida.com/Medicaid/abuse/index.shtml

http://ahca.myflorida.com/Executive/Inspector_General/complaints.shtml

http://oig.hhs.gov/fraud

This page last updated: 9/2/2016 2:19:21 PM   

What is Magellan Complete Care?

Magellan Complete Care is a Florida Medicaid specialty health plan for individuals living with a serious mental illness that combines care for both a member's physical and mental well being.
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Why Magellan Complete Care?

We help our members stay healthy with integrated mental and physical care that is specific to their needs for better overall health. 
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