Report Fraud, Waste and Abuse
Understanding the terms:
- Fraud: Intentional deception or misrepresentation to obtain the money or property of a health care benefit program (by means of false or fraudulent pretenses, representations, or promises).
- Waste: The over-utilization of services or other practices that result in unnecessary costs.
- Abuse: Obtaining payment for items or services when there is no legal entitlement to that payment, but without knowing and/or intentional misrepresentation of facts to obtain payments.
What can you do to help prevent, report, and stop Fraud, Waste, and Abuse?
Report potential fraud:
Contact Care1st
- 1-800-436-6184
- Care1st Attn: Compliance Officer
[ADDRESS] - Email: azchfwa@azcompletehealth.com
Fraud Hotline of the HHS Office of Inspector General
- 1-800-447-8477
- http://oig.hhs.gov/fraud/report-fraud/index.asp
- Email: HHSTips@oig.hhs.gov.
- Mail
U.S. Department of Health and Human Services
Office of the Inspector General
ATTN:OIG Hotline Operations
P.O. Box 23489
Washington, DC 20026.
Contact Arizona Medicaid (AHCCCS)
- Mail: Office of Inspector General (OIG)
801 E. Jefferson St.,
Mail Drop 4500
Phoenix, AZ, 85034 - To Report Provider Fraud:
- In Maricopa County: 1-602-417-4045
- Outside of Arizona Only: 888-ITS-NOT-OK or 1-888-487-6686
- To Report Member Fraud:
- In Maricopa County: 1-602-417-4193
- Outside of Arizona Only: 888-ITS-NOT-OK or 1-888-487-6686
- Email: AHCCCSFraud@azahcccs.gov
- Fax: 1-602‐417‐4102
- Website: https://azahcccs.gov/Fraud/ReportFraud
In addition to notifying these regulators, providers must immediately notify Care1st of all suspected fraud, waste, and/or program abuse.
Care1st providers must report suspected fraud, waste, and program abuse directly to the health plan immediately upon identification and notification to their regulator(s).
To protect the public from consumer fraud.
If you believe you have been the victim of consumer fraud, you may file a consumer complaint with the Arizona Attorney General's Office. For consumer inquiries, or to request a complaint form, call (602) 542-5763 (Phoenix), (520) 628-6648 (Tucson), or toll-free outside of metro Phoenix, (800) 352-8431.