2024 Medi-Cal Member Handbook

 

Fraud, Waste and Abuse

If you suspect that a provider or a person who gets Medi-Cal has committed fraud, waste or abuse, it is your right to report it by calling the confidential toll-free number 1-800-822-6222 or submitting a complaint online at the California Department of Health Care Services (DHCS) website. 

Provider fraud, waste and abuse includes:

  • Falsifying medical records
  • Prescribing more medication than is medically necessary
  • Giving more health care services than medically necessary
  • Billing for services that were not given
  • Billing for professional services when the professional did not perform the service
  • Offering free or discounted items and services to members to influence which provider is selected by the member
  • Changing member’s primary care provider without the knowledge of the member

Fraud, waste and abuse by a person who gets benefits includes, but is not limited to:

  • Lending, selling or giving a health plan ID card or Medi-Cal Benefits Identification Card (BIC) to someone else
  • Getting similar or the same treatments or medicines from more than one provider
  • Going to an emergency room when it is not an emergency
  • Using someone else’s Social Security number or health plan ID number
  • Taking medical and non-medical transportation rides for non-healthcare related services, for services not covered by Medi-Cal, or when you do not have a medical appointment or prescriptions to pick up.

To report fraud, waste and abuse, write down the name, address and ID number of the person who committed the fraud, waste or abuse.
Give as much information as you can about the person, such as the phone number or the specialty if it is a provider.
Give the dates of the events and a summary of exactly what happened.

Send your report to:

     L.A. Care Health Plan
     Special Investigations Unit
     1200 West 7th Street
     Los Angeles, CA 90017

You can also:

All reporting can be done anonymously.