Fraud and abuse

Health care fraud is any act of falsifying health care transactions for financial gain or other benefit. It can be done by a doctor, a business or a member of a health plan. Anyone convicted of this serious crime may go to prison or pay major fines.

How does health care fraud affect you?

Only a small number of people commit health care fraud, the costs to Americans average about $80 billion a year. It increases total health care costs, which means you may have to pay more for benefits.

Types of health care fraud

There are many types of health care fraud:

  • Billing for services that did not happen
  • Health services done simply to get reimbursed
  • Filing claims for services or drugs not received
  • Forging or changing bills, receipts or other forms
  • Doctor shopping to get multiple prescriptions

What are we doing to stop fraud?

HAP Midwest Health Plan uses special software to monitor claims data and other information to show which claims need to be reviewed. HAP has a highly skilled team that seeks out instances of health care fraud. These actions are taken to protect our members.

Report fraud

If you think an action is fraud, please report it right away. We look into every report of health care fraud, waste and abuse.

You can send an anonymous report to HAP Midwest, the Michigan Department of Health and Human Services or the Office of the Inspector General. To report it in writing, include your contract number, date of service and other information that may be useful.

HAP Midwest Health Plan
P.O. Box 2578
Detroit, MI 48202
Attention: Office of Compliance
Compliance Hotline: 24 hours a day at (877) 746-2501

Medicaid
Michigan Department of Health and Human Services
(855) MI-FRAUD or (855) 643-7283
Online: Report Medicaid Fraud and Abuse
In writing: Office of Inspector General
P.O. Box 3047, Lansing, MI 48909

Medicare
Office of Inspector General
Member Fraud: (800) 222-8558
Provider Fraud: (866) 893-9622

Please keep this overview of this important information.