Fraud, Waste, and Abuse
If you, or any entity with which you contract to provide health care services on behalf of AmeriHealth Caritas New Hampshire beneficiaries, become concerned about or identify potential fraud, waste, or abuse, please contact AmeriHealth Caritas New Hampshire or the New Hampshire Department of Health and Human Services (DHHS).
Anonymously report suspected fraud, waste, or abuse
Call: AmeriHealth Caritas New Hampshire Fraud Tip Hotline at 1‑866‑833‑9718.
Email: fraudtip@amerihealthcaritas.com
Mail: Special Investigations Unit, 200 Stevens Drive, Philadelphia, PA 19113
Below are examples of information that will assist AmeriHealth Caritas New Hampshire with an investigation:
- Contact information of the person making the report (e.g., name of individual making the report, address, telephone number). Please note that you can report issues anonymously.
- Name of the individual or entity involved in the potential fraud, waste, and abuse issue.
- Description of the alleged fraud, waste, and abuse activities.
- Approximate dollar amount involved (if known).
- Place of service (if applicable).
- Timeframe/date of the allegation(s).
You may also report suspected fraud, waste, and abuse directly to the New Hampshire DHHS.
- Call 1-603-271-1246.
- Fax: 1-302-255-4425
- Mail:
Department of Health and Human Services
Bureau of Improvement & Integrity, Special Investigations
129 Pleasant Street
Thayer Building
Concord, NH 03301
Fraud, waste, and abuse definitions
Fraud
Any intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to themselves or some other person. It includes any act that constitutes fraud under applicable federal or state law.
Waste
An overutilization of services or other practices that directly or indirectly result in unnecessary costs. Waste is generally not considered to be caused by criminally negligent actions, but rather the misuse of resources.
Abuse
Provider practices that are inconsistent with sound fiscal, business, or medical practices and result either in an unnecessary cost to the federally funded programs or in reimbursement for services that are not medically necessary or provider practices that fail to meet professionally recognized standards for healthcare. It also includes recipient practices that result in unnecessary cost to the federally funded programs.
Examples of fraud, waste, and abuse
- Billing for services not furnished.
- A member using someone else’s insurance card to receive care.
- Submitting false information to obtain authorization to furnish services or items to Medicaid recipients.
- Accepting kickbacks for patient referrals.
- Violating physician self-referral prohibitions.
- Billing for a more costly service than performed.
- Providing, referring, or prescribing services or items that are not medically necessary.
- Providing services that do not meet professionally recognized standards.