Resources

Fraud, waste & abuse

If you think someone or a provider is committing fraud, waste or abuse, please report it. The Magellan Complete Care of Virginia Compliance hotline is available 24 hours a day, seven days a week. You do not have to give your name. An outside company will investigate and keep your name confidential.

What is 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.

Magellan Complete Care of Virginia 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

How can I report fraud, waste or abuse?

You may report fraud, waste or abuse by contacting us in any of the ways listed below: 

  • Corporate Compliance Hotline: 1-800-915-2108
  • Compliance Unit email: Compliance@MagellanHealth.com
  • Magellan Complete Care of Virginia Special Investigations Unit: 1-800-350-2271
  • Corporate Special Investigations Unit: 1-800-755-0850 or SIU@MagellanHealth.com

If you would prefer to refer your fraud, waste, or abuse concerns directly to the DMAS, you can report to the contacts listed below.

Department of Medical Assistance Services Fraud Hotline
Phone: 1-800-371-0824 or 1-866-486-1971 or (804) 786-1066

Virginia Medicaid Fraud Control Unit (Office of the Attorney General)
Email:     MFCU_mail@oag.state.va.us  
Fax:        804-786-3509
Mail:  

Office of the Attorney General
Medicaid Fraud Control Unit
202 North Ninth Street
Richmond, VA 23219

Virginia Office of the State Inspector General Fraud, Waste, and Abuse Hotline

Phone:    1-800-723-1615
Fax:        804-371-0165
Email:     covhotline@osig.virginia.gov
Mail:     

State FWA Hotline
101 N. 14th Street
The James Monroe Building 7th Floor
Richmond, VA 23219

You can also contact the U.S. Department of Health & Human Services Office of Inspector General at:

Office of Inspector General
Department of Health & Human Services
Attn: Hotline
P.O. Box 23489
Washington, DC 20026
Phone: Call 1-800-HHS-TIPS / TTY: 1-800-377-4950
Website: https://oig.hhs.gov/fraud/report-fraud/ 

 

Magellan Complete Care of Virginia helps prevent fraud, waste and abuse by verifying services. We may send you a form asking if you received the services we paid your doctor for. Please fill it out and mail it back in the pre-addressed, postage-paid envelope we send with the form. If you tell us that you did not get the services, we will also report it to DMAS.