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Fraud and Abuse

Committing fraud or abuse is against the law. Fraud is a dishonest act done on purpose.

Examples of member fraud are:

  • Letting someone else use your MO HealthNet Managed Care health plan card(s) or red card or white MO HealthNet card.
  • Getting prescriptions with the intent of abusing or selling drugs.

An example of provider fraud is:

  • Billing for services not provided.

Abuse is an act that does not follow good practices.

  • An example of member abuse is going to the emergency room for a condition that is not an emergency.
  • An example of provider abuse is prescribing a more expensive item than is necessary.

You should report instances of fraud and abuse to:

  • Missouri Care 1-800-322-6027
  • Missouri Care Compliance Hotline 1-866-685-8664
  • MO HealthNet Division Participant Services 1-800-392-2161
  • Or Medicaid Fraud and Control Unit (MFCU) Hotline: 1-800-286-3932

For participant fraud or abuse: 

  • Department of Social Services Division of Legal Services, Investigation Unit 1-573-751-3285
  • Send email to mmac.reportfraud@dss.mo.gov

For provider fraud or abuse:

Report Fraud and Abuse Using this Online Form.

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State Approved: 06/22/2016 MOC16078 Last Updated On: 12/14/2020