Fraud & Abuse
Magellan is dedicated to conducting business in an ethical and legal manner. We are committed to preventing, detecting and reporting fraud, waste, and abuse across various categories of health care related fraud.
What Are 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.
The Bureau of Medicaid Program Integrity wants to prevent Fraud, Waste and Abuse. They check on providers who may be trying to commit fraud with 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.
- Medical records.
- Referral forms.
- Paying or taking a bribe.
What You Can Do
If you think an individual or provider is committing fraud, waste and abuse, please report it.
The Magellan Corporate Compliance hotline is available 24 hours a day, seven days a week. It is handled by an outside company. Callers do not have to give their names. All calls will be investigated and will remain confidential.
- Magellan's Special Investigations Unit hotline: 1-800-755-0850
- Magellan's Special Investigations Unit e-mail: SIU@MagellanHealth.com