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
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:
- Magellan's Special Investigations Unit e-mail: SIU@MagellanHealth.com
You can also contact the Bureau of Medicaid Program Integrity
hotline to report suspected Medicaid fraud. You do not
have leave your name.
To report suspected Medicaid fraud, call