Fraud Prevention Tips

Molina Healthcare of Michigan ("Molina") seeks to uphold the highest ethical standards for the provision of health care benefits and services to its members and supports the efforts of federal and state authorities in their enforcement of prohibitions of fraudulent practices by providers or other entities dealing with the provision of health care services.

Definitions:

Federal False Claims Act, 31 USC Section 3279

The False Claims Act is a federal statute that covers fraud involving any federally funded contract or program. The act establishes liability for any person who knowingly presents or causes to be presented a false or fraudulent claim to the U.S. government for payment. The term "knowing" is defined to mean that a person with respect to information:

• Has actual knowledge of falsity of information in the claim;
• Acts in deliberate ignorance of the truth or falsity of the information in a claim; or
• Acts in reckless disregard of the truth or falsity of the information in a claim.

The act does not require proof of a specific intent to defraud the U.S. government. Instead, health care providers can be prosecuted for a wide variety of conduct that leads to the submission of fraudulent claims to the government, such as knowingly making false statements, falsifying records, double-billing for items or services, submitting bills for services never performed or items never furnished or otherwise causing a false claim to be submitted.

Health care fraud is:

Health care fraud includes but is not limited to the making of intentional false statements, misrepresentations or deliberate omissions of material facts from, any record, bill, claim or any other form for the purpose of obtaining payment, compensation or reimbursement for health care services.

​Preventing Fraud, Waste, and Abuse

• Do not give your Molina ID card or number to anyone except your doctor, clinic, hospital or other healthcare provider.
• Do not let anyone borrow your Molina ID card.
• Never lend your social security card to anyone.
• When you get a prescription make sure the number of the pills in the bottle matches the number on the label.
• Never change or add information on a prescription.
• If your Molina ID card is lost or stolen, report it to Molina immediately.

Reporting Fraud, Waste, and Abuse

You may report suspected cases of fraud and abuse to Molina's Compliance Officer. You have the right to have your concerns reported anonymously to Molina and/or the State of Michigan Department of Insurance and Financial Services. When reporting an issue, please provide as much information as possible. The more information provided the better the chance the situation will be successfully reviewed and resolved. Remember to include the following information when reporting suspected fraud or abuse:

• Nature of complaint
• The names of individuals and/or entity involved in suspected fraud and/or abuse including address, phone number, Medicaid ID number and any other identifying information.

You may report fraud, waste, and abuse to Molina Healthcare through one of the following:

Telephone

The Molina Healthcare Alert Line is available 24/7. It can be reached at any time (day or night), over the weekend, or even on holidays.

To report an issue by telephone, call toll-free at (866) 606-3889.

Online

Regular Mail

Write (marked confidential) to: Compliance Officer, Molina Healthcare of Michigan, 100 West Big Beaver, Suite 600, Troy, MI 48084.

Department of Insurance and Financial Services