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Fraud, waste and abuse

Mercy Care Advantage takes fraud, waste and abuse seriously. Learn how to identify, prevent and report it. This is everyone’s responsibility. Learn more about Medicare fraud. Find helpful info and tips to help you spot and prevent possible fraud, waste and abuse.

Report fraud, waste and abuse

Fill out the online form on this page. Complete as much info as you can. If you provide your contact info, we’ll keep your identity private.

You can also report fraud, waste and abuse to:


FAQs about fraud, waste and abuse

It’s against the law to commit fraud or abuse. Medicare fraud wastes a lot of money every year. This leads to higher health care costs and taxes for all of us. 

Not yet a member?

Call Member Services at 602-586-1730 or 1-877-436-5288 (TTY 711). We’re here for you 8 a.m. to 8 p.m., 7 days a week.

Fraud happens when someone commits a dishonest act on purpose to benefit themselves. Or it may benefit someone it isn’t meant for. 

Examples of fraud can include billing for:

  • Items and services a provider didn’t provide

  • Items or services a provider didn’t fully document or that weren’t medically necessary

Waste happens when someone gets benefits or services (for themselves or others) that are not meant for them or they don’t need. Some examples of waste include:

  • Going to an emergency room if you know it’s not an emergency

  • Getting medicine or services you don’t need

Abuse happens when someone’s actions:

  • Result in needless costs to Medicare

  • Don’t match accepted and sound money, business, or medical practices

  • Result in costs or in reimbursement for services that aren’t medically necessary 

  • Result in costs that don’t meet professionally recognized standards for health care

It may be abuse if a provider:

  • Misuses codes on a claim

  • Charges too much for services or supplies

  • Bills for services that weren’t medically necessary 

Con artists may try to steal your identity and commit Medicare fraud. They may try to get your Medicare Number or personal info to do this. Remember:

  • No one from Medicare will contact you for your Medicare Number or other personal info. Not unless you’ve given them permission in advance. 

  • No one from Mercy Care Advantage will contact you to ask for your Medicare Number or other personal info either.

Here’s how you can help protect yourself and Medicare:

  • Protect your Medicare Number (on your card) and your Social Security number (on your Social Security card). Treat your Medicare card like it's a credit card. Protect your Mercy Care Advantage ID card.

  • Remember that nothing is ever "free." Don't accept offers of money or gifts for free health care.

  • Ask questions and learn about your Medicare and Mercy Care Advantage plan coverage.  

I want to report fraud, waste or abuse

Tell us about fraud, waste or abuse you suspect. You’ll want to fill in all fields with an asterisk (*).

Tell us why you suspect this person, company or facility of wrongdoing. For example, what they did, when it happened and anything else you need us to know. 

Your info (optional)

You don’t need to give us your name or contact info. But if you choose to, we’ll keep it private. You can also choose to give us just your contact info and not your name.  

We’ll only review the info that you choose to report. You’ll want to give us as much info as you can. That way, we can understand what happened.