Fraud, Waste & Abuse

What is Fraud, Waste and Abuse?

Intentional deception or misrepresentation to obtain the money or property of a health care benefit program (by means of false or fraudulent pretenses, representations, or promises).

The over-utilization of services or other practices that result in unnecessary costs.

Obtaining payment for items or services when there is no legal entitlement to that payment, but without knowing and/or intentional misrepresentation of facts to obtain payments.

What can you do to help prevent, report, and stop Fraud, Waste, and Abuse?
Report potential fraud:
Medicare Fraud Hotline of the HHS office Inspector General: (800) 447-8477
HHSC/OIG Inspector General: (800) 436-6184
Web: Report Fraud
American Health Advantage of Oklahoma: (866) 583-4649 (TTY/TDD 711) 8:00 am to 8:00 pm seven days a week October 1 through March 31; Monday to Friday April 1 through September 30
Stop Medicare Fraud