Fraud, waste and abuse
As a member of Mercy Care Long Term Care, you have a right to receive quality health care. If you feel you have been treated unfairly, have difficulty seeing your doctor, or have any other health care issues, please call Member Services at 602-263-3000 or 1-800-624-3879 (TTY/TDD 1-866-602-1982).
Help prevent fraud and abuse Caregivers must complete time sheets that accurately reflect the hours they have worked. Caregivers who fraudulently fill in time and their hiring agencies could be held liable for falsifying information.
You can take the following steps to help stop fraud and abuse.
- Never sign a blank time sheet or a time sheet that is not completely filled in.
- Never sign a time sheet if you know the caregiver did not work the time listed. This is fraud. If this happens, call the agency or your case manager to report this situation.
- Never sign a time sheet if it is for dates you were in the hospital. Caregivers cannot provide you care or care for your house while you are in the hospital. This is fraud. In addition, caregivers cannot “make up” the time once you return from the hospital. This can be considered fraud. For example, if you needed bathing assistance five days a week and were in the hospital for four days, the caregiver cannot visit you on the fifth day and try to make up the time for the first four days.
We understand that during these difficult economic times it may be tempting to help caregivers get a full paycheck even if they haven’t provided all the care that they were assigned to provide. However, this is considered fraud and an abuse of the Medicaid health system.
Report fraud 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 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 Plan Fraud Hotline: 1‑800‑810‑6544
AHCCCS Fraud Reporting: 602‑417‑4193 or 1‑888‑487‑6686