Haris Ashley
If you suspect medical insurance fraud in Florida, you can report it in several ways. Sunshine Health, for example, has a Consumer Complaint Hotline that you can call to report suspected fraud, waste, abuse, or neglect in the Medicaid, Long Term Care, or Florida Healthy Kids programs. You can also submit an anonymous complaint to Florida Blue's Special Investigation Unit, which investigates suspected or committed fraudulent insurance acts, including billing for a service that was never rendered and misrepresenting services provided. The Florida Attorney General's Office also accepts complaints of healthcare fraud via phone or online.
| Characteristics | Values |
|---|---|
| Who to report to | Florida Blue's Special Investigation Unit, Florida Attorney General's Office, Florida Department of Agriculture and Consumer Services, Sunshine Health, Florida Department of Financial Services, Division of Public Assistance, Florida Department of Children and Families, Office of Public Benefits Integrity, Office of the Attorney General, Office of Medicaid Program Integrity of the Inspector General at the Agency for Health Care Administration |
| How to report | Online, by phone, by mail |
| Anonymity | Anonymous reports are accepted |
| Reward | Those who report fraud may be entitled to a reward if their report results in a fine, penalty or forfeiture of property |
| What constitutes fraud | Billing for a service that was never rendered, duplicate submission of a claim for the same service, misrepresenting the services provided, billing for patients who did not receive services, billing for equipment that wasn't provided, billing for items and services that the patient no longer needs, loaning, selling or giving your Sunshine Health member ID card or Medicaid ID card to someone, misusing Sunshine Health or Medicaid benefits, billing Sunshine Health for "free" services, wrongful billing to Sunshine Health by a provider, knowingly getting benefits or payments that you are not entitled to receive |
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What You'll Learn
Report to the Florida Department of Financial Services
To report suspected Medicaid fraud by eligible Medicaid recipients, you can contact the Florida Department of Financial Services, Division of Public Assistance Fraud Hotline at 1-866-762-2237. You can also report suspected fraud by phone, through the Internet, or by regular mail. You can choose to remain anonymous, but providing your name and contact information may be helpful for future investigations.
Before submitting a report, it is advisable to gather as much information as possible, including the name of the individual or entity suspected of committing fraud. This could be a person receiving medical benefits or a healthcare professional, hospital, nursing home, or other facility providing Medicaid services.
Some examples of Medicaid fraud include:
- Billing for patients who did not receive services
- Billing for services and/or equipment that was not provided
- Billing for items and services that the patient no longer needs
- Wrongful billing or billing for "free" services
If you believe you have been a victim of a product or company's fraudulent health claims, you can also file a complaint with the Attorney General's Office online at www.myfloridalegal.com or by phone at 1-866-966-7226.
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File a complaint with the Attorney General's Office
If you believe you have been the victim of a product or company's fraudulent health claims, you can file a complaint with the Attorney General's Office. This can be done online at www.myfloridalegal.com or by phone at 1-866-966-7226. You may also remain anonymous when filing your complaint.
Before filing a complaint, it is recommended that you gather as much information as possible, including the name of the person or entity you suspect of committing fraud. This could be a person receiving medical benefits or a healthcare professional, hospital, nursing home, or other facility providing Medicaid services.
The Attorney General's Office takes the issue of healthcare fraud seriously and welcomes the assistance of citizens in combating it. Under Florida's False Claims Act, individuals who report Medicaid fraud are entitled to a share of any funds recovered by the state.
Additionally, if you believe a doctor, hospital, another Sunshine Health member, or any other person is misusing Medicaid or Sunshine Health resources, you can contact the Florida Attorney General's Office, Medicaid Fraud Division, at the following address:
Florida Attorney General’s Office
Medicaid Fraud Division
107 West Gaines Street
Tallahassee, FL 32301
1-850-414-3300
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Report to the Florida Department of Children and Families
If you suspect Medicaid fraud by an ineligible recipient, you can report this to the Florida Department of Children and Families. This can be done by visiting their website, https://www.myflfamilies.com/services/public-assistance/public-benefits-integrity. Here, you can file a report online or find other contact information to get in touch with the relevant authorities.
Before submitting a report, it is advisable to gather as much information as possible. This includes the name of the person or entity suspected of committing fraud. This could be an individual receiving medical benefits or a healthcare professional, hospital, nursing home, or any other facility providing Medicaid services. Other relevant information could be specific details of the suspected fraud, such as dates, locations, and any documentation or communication related to the case.
It is important to note that you should not share your Medicaid card number with anyone except your doctor, hospital, or healthcare provider. If you believe your Medicaid benefits are being misused, you should report this immediately to Sunshine Health, who will take your call seriously and can advise on further steps.
Additionally, if you are aware of suspected fraud, waste, abuse, or neglect in the Medicaid, Long Term Care, or Florida Healthy Kids programs, you can contact the Consumer Complaint Hotline toll-free at 1-888-419-3456 or Sunshine Health's WAF Hotline at 1-866-685-8664.
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Report Medicaid fraud to the Attorney General
Medicaid fraud can be reported to the Attorney General's Medicaid Fraud Control Unit (MFCU). The MFCU investigates and prosecutes criminal and civil fraud involving providers who improperly bill the state's Medicaid program. Medicaid fraud can also include billing for a service that was never rendered, duplicate submission of a claim for the same service, and misrepresenting the services provided.
To report suspected fraud, you can submit a complaint form online or by mail. The online form can be found on the Attorney General's Medicaid Fraud Control Unit page. To submit by mail, send a completed form to the following address:
Florida Attorney General’s Office
Medicaid Fraud Division
107 West Gaines Street
Tallahassee, FL 32301
You can also call the Attorney General's office at 1-850-414-3300 or 1-866-966-7226. Additionally, you may be eligible for a reward through the Attorney General's Fraud Recovery Program if your report results in a fine, penalty, or forfeiture of property from a doctor or other healthcare provider.
It is important to note that you can also submit an anonymous complaint to report fraud to the Special Investigation Unit or make a report of possible unethical or improper actions through a third-party vendor, such as EthicsPoint.
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Report to the Florida Department of Agriculture and Consumer Services
If you suspect medical insurance fraud in Florida, you can file a complaint with the Florida Department of Agriculture and Consumer Services, which acts as the State's consumer complaint clearinghouse. This can be done online at www.floridaconsumerhelp.com.
The Florida Department of Agriculture and Consumer Services is just one of several avenues to report medical insurance fraud in Florida. Other options include:
- Reporting to the Florida Attorney General's Office, either online at www.myfloridalegal.com or by phone at 1-866-9-NO-SCAM.
- Reporting to the Florida Department of Financial Services, Division of Public Assistance fraud hotline at 1-866-762-2237.
- Reporting to the Florida Department of Children and Families, Office of Public Benefits Integrity at https://www.myflfamilies.com/services/public-assistance/public-benefits-integrity.
- Reporting to the Office of Medicaid Program Integrity of the Inspector General at the Agency for Health Care Administration, either online using the Medicaid billing fraud online complaint form or by telephone at 1-888-419-3456.
- Reporting to the Special Investigation Unit of Florida Blue, either online or by downloading and submitting a PDF form. You can also submit an anonymous complaint or make a report of possible unethical or improper actions through their third-party vendor, EthicsPoint.
Before making a report, it is recommended to gather as much information as possible, including the name of the suspected individual or entity, as well as any other relevant details. It is important to note that you can choose to remain anonymous when reporting suspected fraud, but providing your contact information can be helpful for investigators seeking additional information.
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Frequently asked questions
Medical insurance fraud is when an individual receives benefits or payments they are not entitled to receive. It also includes billing for services or equipment that was not provided.
You can report suspected medical insurance fraud in Florida by calling the Consumer Complaint Hotline at 1-888-419-3456 or the Florida Department of Financial Services, Division of Public Assistance fraud hotline at 1-866-762-2237. You can also submit a report online via the Florida Medicaid website or by filling out a form and submitting it by mail.
Yes, you can choose to remain anonymous when reporting fraud. However, providing your name and contact information can be helpful for future investigations.
Before submitting a report, try to gather as much information as possible about the suspected individual or entity. This includes their name, the nature of the fraud, and any other relevant details.
Individuals who commit medical insurance fraud in Florida may face fines, penalties, or forfeiture of property. Those who report fraud may be eligible for a reward through the Attorney General's Fraud Recovery Program if their report leads to a successful criminal case.
