Vaya Health is committed to preventing and identifying fraud and abuse in the Medicaid program. You can help by reporting any suspicious billing practices or other activity you think may be fraud or abuse.
What is Medicaid fraud or abuse?
Medicaid fraud occurs when a health care provider submits a false or fraudulent claim or when a person intentionally lies or conceals income or assets to obtain government benefits. Abuse occurs when a person or health care provider engages in activities that result in unreasonable or excessive cost to the Medicaid program, including a Medicaid managed care organization, such as Vaya.
The federal government estimates fraud and abuse costs U.S. taxpayers billions of dollars every year. Examples of fraud and abuse may include:
- You fail to report all your income or other insurance when applying for Medicaid.
- You let someone else use your Medicaid card to obtain services.
- Someone steals your Medicaid card and uses it without your permission.
- A provider bills Vaya for services or supplies that you never received.
- A provider bills Vaya for services that were not medically necessary, not coded properly or not supported by all required documentation.
- A provider’s reported credentials are false.
How do I report fraud and abuse?
You can remain anonymous, but detailed information will help us with our investigation. (In rare cases involving legal proceedings, Vaya may have to reveal who you are.) When you contact us, please provide the name/Medicaid ID number of the Medicaid beneficiary involved, the name of the provider, the date(s) of service, the amount of claims billed or paid, and a description of the fraudulent or suspicious activity.
You can report suspected fraud and abuse in any of the following ways:
- Call Vaya’s 24/7 Confidential Compliance Hotline at 1-866-916-4255 (allows for anonymous reporting).
- Use the EthicsPoint compliance portal.
- Call the state’s Medicaid Fraud, Waste, and Program Abuse Tip Line at 1-877-DMA-TIP1 (1-877-362-8471).
- Call the NC Medicaid Customer Service Center at 1-800-662-7030.
- Call the NC State Auditor’s Waste Line at 1-800-730-TIPS (1-800-730-8477).
- Call the U.S. Office of Inspector General’s Fraud Line at 1-800-HHS-TIPS (1-800-447-8477).
How can I help prevent fraud and abuse?
- DO protect your Medicaid number (on your Medicaid card) and your Social Security Number (on your Social Security card). Treat your Medicaid card like it is a credit card.
- DO ask questions. You have a right to know everything about your care and treatment, including costs billed to Vaya by your provider.
- DO remember that nothing is ever “free.” Don’t accept offers of money or gifts for free medical care.
- DON’T share your Medicaid card, Medicaid number, Social Security card, or Social Security Number with anyone (including marketers, solicitors, family, or friends) except your doctor or other authorized provider.
- DON’T accept gifts or money such as gift cards in exchange for your Medicaid number.
- DON’T share medical records or other sensitive information with anyone except Vaya or another insurance company, or a doctor, agency, clinic, hospital, or other health care provider.
