Washington Apple Health (Medicaid) Fraud, Waste & Abuse

What is fraud, waste, and abuse?

Fraud: When someone lies or tricks others to get money or something they want. Some examples are signing someone else’s name on a form, lying to get paid, or sending in fake medical bills. Federal and state laws say what is considered fraud.

Waste: When too much of something is used without needing it — often by accident. This can happen when there aren’t clear rules to follow. For example, it’s wasteful if two doctors order the same lab tests for a person.

Abuse: Not following the industry standard for ordering medical procedures or billing for them. Some examples include a doctor who uses the wrong billing code for a service or when a patient orders healthcare supplies they don’t need.

Learn more at fighthealthcarefraud.com

Two ways to report Medicaid fraud, waste, or abuse

You can report a care provider in our health plan network or someone with Apple Health Medicaid:

1. Through the Wellpoint Special Investigations Unit (SIU).
   
   Online
   Report Form | Fraud, Waste & Abuse
   
   Phone
   866-847-8247 (TTY 711)
   
   Mail
   Special Investigations Unit
   740 W. Peachtree St. NW
   Atlanta, GA 30308
   
   Or:
   
   
2. In your state of Washington through the Medicaid Fraud Control Unit (MFCD).
   
   Online
   Complaint form (MFCD)
   
   Phone
   360-586-8888 (TTY 711)
   
   Email
   MFCUreferrals@atg.wa.gov
   
   Mail
   Office of the Attorney General
   Medicaid Fraud Control Division
   P.O. Box 40114
   Olympia, WA 98504