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Fraud & Abuse
Committing Medicaid fraud or abuse is against the law.
Fraud is a dishonest act done on purpose.
Examples of member fraud are:
- Letting someone else use your Mo HealthNet Managed Care health plan card(s) or red MC+ card
or
- Getting prescriptions with the intent of abusing or selling drugs.
An example of provider fraud is:
- Billing for services not provided.
Abuse is an act that does not follow good practices.
An example of member abuse is:
- Going to the emergency room for a condition that is not an emergency.
An example of provider abuse is:
- Prescribing a more expensive item than is necessary.
You can report a caseonline or you can report instances of fraud and abuse to:
Harmony Health Plan
1-866-822-1340
or
Missouri Division of Medical Services
Recipient Services
1 (800) 392-2161
MO Approval Date: 08/11/2006
