Fraud, Waste and Abuse
Committing fraud or abuse is against the law. Your health benefits are given to you based on your health and financial status. You should not share your benefits with anyone. If you misuse your benefits, you could lose your AHCCCS benefits. AHCCCS may also take legal action against you. If you think a person, member or provider is misusing the program, please call Mercy Care Plan Member Services or AHCCCS. Fraud and abuse also means loaning, selling or giving your member ID card to someone, inappropriate billing by a provider or any action intended to defraud the AHCCCS program. Fraud is a dishonest act done on purpose. Examples of member fraud are:
- Letting someone else use your Mercy Care ID card
- Getting prescriptions with the idea of abusing or selling drugs
- Changing information on your Mercy Care ID card
- Changing information on a prescription
Abuse can mean providers that take actions resulting in needless costs to AHCCCS. This includes providing medical services that are not required. It may also mean the provider does not meet required health care standards. Abuse can also include member actions that result in extra cost to AHCCCS. Abuse means provider practices that are inconsistent with sound financial, business, or medical practices. This can result in an unnecessary cost to the Medicaid program. Abuse can also be a refund for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes member practices that result in unnecessary cost to the Medicaid program.
Reporting If you think a person, member or provider is misusing the program, please let us know.
Mercy Care Fraud Hotline: 1‑800‑810‑6544
To report Fraud, Waste and Abuse directly to AHCCCS-OIG, referrals can be made via phone for provider suspected fraud at 602-417-4045 or 888-ITS-NOT-OK or 888-487-6686. Member fraud referral calls can be made to 602-417-4193 or 888-ITS-NOT-OK or 888-487-6686. Fraud, Waste and Abuse referrals may also be emailed to AHCCCS at AHCCCSFraud@azahcccs.gov, or submitted to AHCCCS OIG at https://www.azahcccs.gov/Fraud/ReportFraud/