Report Fraud, Waste, and Abuse

Unfortunately, there may be times when you see fraud or abuse relating to Medicaid services.

Examples of provider fraud and abuse

• Billing or charging you for services that AmeriHealth Caritas Delaware covers.
• Offering you gifts or money to get treatment or services you do not need.
• Offering you free services, equipment, or supplies in exchange for using your AmeriHealth Caritas Delaware member number.
• Giving you treatment or services you do not need.
• Physical, mental, or sexual abuse by medical staff.

Examples of member fraud and abuse

• Members selling their ID cards to other people.
• Members lending their ID cards to other people.
• Members abusing their benefits by seeking drugs or services that are not medically necessary.

How to report fraud and abuse

You can report fraud and abuse by calling the AmeriHealth Caritas Delaware Hotline number at 1-866-833-9718. You can also report fraud and abuse to Delaware Health and Social Services (DHSS).

• To report member or provider fraud and abuse, call toll free at 1-866-833-9718, Monday through Friday, from 7 a.m. to 6 p.m. You can also call 1-866-833-9718 to report member or provider fraud and abuse anonymously.
• Report member or provider fraud and abuse online with the U.S. Department of Health and Human Services at the Office of Inspector General. You do not have to give your name, but if you do, the provider or member will not be told it was you who made the report.

Reporting abuse, neglect, and exploitation

AmeriHealth Caritas Delaware members have the right to be free from abuse, neglect, and exploitation. It is important that you understand how to identify these situations and how to report them.

Abuse can be:

• Physical abuse.  
• Emotional abuse.  
• Sexual abuse.

It includes pain, injury, mental suffering, being locked up or held in a place against your will, and other cruel treatment.

Neglect can be:

• When you can’t take care of yourself or get the care your need, placing your life at risk. This is “self-neglect.”
• When your caregiver is not taking care of your basic needs, putting you at risk for harm to your health or safety. The neglect may be unintended due to the caregiver’s inability to provide or arrange for your care. Neglect also may be due to the carelessness of the caregiver to meet your needs.

Exploitation (if you were made to do something you don’t want to do or were asked to do something without knowing the real reason for doing so) can include:

• Fraud or bullying.
• Forgery.
• Unauthorized use of banking accounts or credit cards.

Financial exploitation occurs when a caregiver improperly uses funds intended for your care. These are funds paid to you or the caregiver by a governmental agency.

If you think you or another AmeriHealth Caritas Delaware member is a victim of these situations, please notify your Clinical Care Coordinator or contact one of the agencies below:

• Adult Protective Services
  Division of Services for Aging and Adults with Physical Disabilities (DSAAPD)
  Call: 1-800-223-9074
  Email: delawareadrc@state.de.us
• Child Protective Services
  Department of Services for Children, Youth, and their Families
  Call: 1-800-292-9582
  Online form: Online Child Abuse and Neglect Report
• Complaint & Incident Reporting for long-term care facilities
  Division of Long Term Care Residents Protection (DLTCRP)
  Call: 1-877-453-0012
  Online form: LTC Complaint Form