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:
- Missouri Medicaid Audit & Compliance Investigations 1-573-751-3285 or 1-573-751-3399
- Send email to mmac.reportfraud@dss.mo.gov
