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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 
NC Division of Medical Assistance - High quality health care through Medicaid and Health Choice for Children.

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Medicaid Contacts

 


Fraud and Abuse

Medicaid fraud and abuse is when a person knowingly cheats or is dishonest.  The dishonesty results in a benefit such as payment or coverage.

Examples of Medicaid fraud and abuse:

  • An individual does not report all income when applying for Medicaid.
  • An individual does not report other insurance when applying for Medicaid.
  • A non-recipient uses a recipient's card with or without the recipient's knowledge.
  • A provider’s credentials are not accurate.
  • A provider bills for services which were not rendered.
  • A provider performs and bills for services not medically necessary.

Reporting Provider Fraud and Abuse

You are encouraged to report matters involving Medicaid fraud and abuse. If you want to report fraud or abuse, you can remain anonymous; however, sometimes in order to conduct an effective investigation, staff may need to contact you. Your name will not be shared with anyone investigated. (In rare cases involving legal proceedings, we may have to reveal who you are.)


To Report Provider Fraud and Abuse

  • Contact the Division of Medical Assistance by calling the DHHS Customer Service Center at 1-800-662-7030 (English, Spanish) or
  • Call the Medicaid fraud, waste and program abuse tip-line at 1-877-DMA-TIP1 (1-877-362-8471) or
  • Call the Health Care Financing Administration Office of Inspector General's Fraud Line at 1-800-HHS-TIPS or
  • Call the State Auditor's Waste Line: 1-800-730-TIPS or
  • Complete and submit a Medicaid fraud and abuse confidential online complaint form.

To Report Recipient Fraud and Abuse


Concerns/Complaints

If you have been denied benefits and disagree with this decision, you may ask for an appeal. Contact your worker at the Department of Social Services who sent the letter denying benefits.  If you are uncertain whom to call, contact the DHHS Customer Service Center: 1-800-662-7030.

 

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