Report Fraud, Waste, or Abuse (Medicaid)

HomeFirst Managed Long-Term Care Plan is committed to an environment where open, honest communication is the expectation, not the exception.

Most doctors, home care workers, and other providers are honest. A few are not. If you think someone is cheating Medicaid, please tell us.

On this page 

• What fraud, waste, and abuse mean
• Signs to watch for
• How to report to HomeFirst
• Other places you can report
• What to have ready

What fraud, waste, and abuse mean

• Fraud is when someone lies or tricks on purpose to get money from a health program.
• Waste is using more services than needed, or using health care money carelessly. This raises costs for everyone.
• Abuse is when actions lead to extra costs, or to payment for care that is not needed or not up to health care standards.

Signs to watch for

• A bill or statement lists care, visits, or equipment you never got.
• You are billed more than once for the same service.
• Someone offers you money or gifts to get care or services from them.
• A provider orders tests or prescriptions you do not need.
• Someone else uses your HomeFirst or Medicaid card.

Protect yourself: Keep your cards safe, like a credit card. Do not lend your card to anyone. Check your bills and statements for mistakes.

How to report to HomeFirst

If you would like to report a potential compliance issue or potential fraud, waste, or abuse (FWA), you have three options:

1. Contact the Elderplan Compliance Officer.
   Candice Weatherly
   Phone: 718-759-4260
   Email: cweather@mjhs.org
2. Report online.
   Submit your question or concern electronically to the Elderplan Compliance and Ethics Hotline (opens a non-HomeFirst website). To ensure confidentiality, a third-party vendor operates the hotline.
3. Call the anonymous hotline.
   Call the anonymous Elderplan Compliance and Ethics Hotline at 1-855-395-9169. You do not have to give your name. To ensure confidentiality, a third-party vendor operates the hotline.

Other places you can report

For Medicaid:

• New York State Medicaid Fraud Hotline (Office of the Medicaid Inspector General): Call 1-877-87-FRAUD (1-877-873-7283). Or report online at omig.ny.gov (opens a non-HomeFirst website). You do not have to give your name.
• U.S. Department of Health and Human Services, Office of Inspector General: Call 1-800-HHS-TIPS (1-800-447-8477). TTY users call 1-800-377-4950. Or report online at tips.oig.hhs.gov (opens a non-HomeFirst website).

If you also have Medicare:

• Medicare: Call 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. Calls are free, 24 hours a day, 7 days a week.

What to have ready

It helps to have:

• The name of the doctor, home care agency, supplier, or company
• What happened and the date it happened
• Any bills or statements about it
• Your name and member ID number, unless you want to stay anonymous