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Fraud and Abuse

Billions of dollars are lost to health care fraud every year. What is health care fraud, waste and abuse? It’s when false information is given on purpose. This can be done by a member or provider and can lead to someone getting a service or benefit that is not allowed.

Here are some other examples of provider and member fraud, waste and abuse:

  • Billing for a more expensive service than what was actually given
  • Billing more than once for the same service
  • Billing for services you did not get
  • Falsifying a patient’s diagnosis to justify tests, surgeries or other procedures that aren’t medically necessary
  • Filing claims for services or medications not received
  • Forging or altering bills or receipts
  • Misrepresenting procedures performed to get payment for services that are not covered
  • Waiving patient co-pays or deductibles
  • Using someone else’s WellCare of Nebraska ID card
  • Sharing your own WellCare of Nebraska ID card with another person

To Report Fraud, Waste and Abuse with WellCare of Nebraska

One way you can help stop fraud, waste and abuse is to review your Explanation of Benefits (EOB) when you get it in the mail. Look for any service that you did not receive or any provider you did not see.

If you know of any fraud that has occurred, call our 24-hour fraud hotline. The toll-free number is 1-866-678-8355. It’s private. You can leave a message without leaving your name. If you do leave a number, we’ll call you back. We’ll call to make sure the information we have is complete and accurate.

Report Fraud and Abuse using this online form.
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Last Updated On: 3/2/2018