Resources

MEDICAID INFORMATION

Medicaid is the medical assistance program that provides access to health care for low-income families and individuals.  Medicaid also assists aged and disabled people with the costs of nursing facility care and other medical expenses.  Eligibility for Medicaid is usually based on the family’s or individual’s income and assets.

In Florida, the Agency for Health Care Administration (AHCA) is responsible for Medicaid. AHCA is the equivalent of the corporate head office.  The Department of Children and Families acts as their agent by enrolling people in Medicaid.  AHCA contracts with other state agencies and private organizations to provide the broad range of services that Medicaid offers its participants.

You can get more information at:

Fraud, Waste & Abuse

Reporting Abuse, Neglect, or Exploitation.  You can report abuse, neglect, or exploitation by calling the abuse hotline at 800-96-ABUSE.

Definition of Fraud, Waste, and Abuse

  •  Fraud refers to a false action that is used to gain something of value
  •  Waste is the misuse of services
  •  Abuse refers to overused or unneeded services

CM Community Services, Inc. is dedicated to conducting business in a legal manner. We are committed to preventing, detecting and reporting fraud, waste, and abuse. In addition, the Bureau of Medicaid Program Integrity wants to prevent fraud, waste, and abuse. They check on anybody including members, providers, and vendors who may be trying to commit fraud, waste or abuse against the Medicaid Program. They also:

  •  Recover overpayments
  •  Issue warnings
  •  Send possible fraud cases for investigation

Examples of Fraud, Waste, and Abuse:

  •  Medical services that are not needed
  •  Billing for services that were not provided
  •  Billing for services not covered by Medicaid
  •  Billing twice for the same service
  •  Using a billing code to get extra payments
  •  Using another person’s identity to get Medicaid services

Making false documents by changing:

  •  The date of service for a claim
  •  Prescriptions
  •  Medical records
  •  Referral forms
  •  Paying or taking a bribe

If you think someone or a provider is committing fraud, waste, and abuse, please report it. The CM Community Services, Inc. phone line is available during regular business hours 9:00 am to 5:00 pm Monday to Friday. Callers do not have to give their names. All calls will be investigated and will remain confidential.

To report suspected fraud or abuse in Florida Medicaid call the consumer Complaint Hotline toll-free at 888-419-3456 or complete a Medicaid Fraud and Abuse Complaint Form, which is available online at  https://apps.ahca.myflorida.com/inspectorGeneral/fraud_complaintform.aspx

If you report suspected fraud and your report results in a fine, penalty or forfeiture of property from a doctor or other health care provider, you may be eligible for a reward through the Attorney General’s Fraud Rewards Program, toll-free 866-966-7226 or 850-414-3990.

The reward may be up to twenty-five percent (25%) of the amount recovered, or a maximum of $500,000 per case (Section 409.9203, Florida Statutes).

You can talk to the Attorney General’s Office about keeping your identity confidential and protected. You can report suspected fraud, waste, and abuse to the Florida Department of Financial Services Division of Insurance Fraud: Contact the DFS Fraud Hotline at 1-800- 378-0445.

You can also contact the U.S. Department of Health & Human Services Office of Inspector General at 1-800-447-8477 or by e-mail to HHSTips@oig.hhs.gov or by mail to the address below.

U.S. Department of Health and Human Services
Office of Inspector General
ATTN: OIG HOTLINE OPERATIONS
PO Box 23489
Washington, DC 20026

More information is available at:

http://ahca.myflorida.com/Medicaid/abuse/index.shtml

http://ahca.myflorida.com/Executive/Inspector_General/complaints.shtml

http://oig.hhs.gov/fraud