Fraud Prevention

You Can Stop Fraud, Waste, and Abuse

Health care fraud, waste, and abuse cost taxpayers billions of dollars each year. You can help stop fraud by reporting it. Some types of health care fraud are:

  • Using someone else's ID card to get a service or product;
  • Doctors billing for a service not performed, or billing for a service or product that is not needed;
  • Getting drugs for someone else using a health plan ID or drug card;
  • Selling or giving your prescription drugs to anyone else; and
  • Falsifying eligibility information in order to gain coverage.

If you suspect fraud by our health plan, doctors, drug stores, or members, report it by calling:

  • For all Alliance programs: 1-855-747-2234
  • To report directly to Medi-Cal: 1-800-822-6222
  • To report directly to Medicare: 1-877-772-3379

What is Health Care Fraud?

Health care fraud includes but is not limited to, the making of intentional false statements, misrepresentations or deliberate omissions of material facts from any record, bill, claim or any other form for the purpose of obtaining payment, services, or any type of compensation for health care services for which you are not entitled.

Examples of Fraud

By a Member:

  • Lending an Alliance ID card to someone other than the member;
  • Pretending to be someone else to obtain services;
  • Altering or forging a prescription;
  • Concealing assets or income in order to gain coverage; and
  • Falsifying information in order to obtain narcotic drugs.

By a Provider:

  • Billing for services, procedures and supplies not rendered, or different from what was rendered, to the patient;
  • Providing serviced to patients that are not medically necessary;
  • Balance billing a Medi-Cal member for Medi-Cal covered services; and
  • Unbundling or up-coding procedures.

By a Pharmacy:

  • Billing for a brand name prescription when dispensing a generic;
  • Dispensing a different medication than was prescribed;
  • Altering the quantity of the prescription without proper documentation; and
  • Buying back prescription drugs for resale.

For more, please see How to Report Fraud, Waste, and Abuse.

Thank you for helping us fight fraud, waste, and abuse.