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 1-866-678-8355
• 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

Report Fraud and Abuse Using this Online Form.