Reporting Fraud & Abuse
Members need to use behavioral health services properly. It is considered fraud if a member or provider is dishonest in order to:
- Get a service not approved for the member
- Get AHCCCS benefits that a person is not eligible for
Abuse happens if a member causes unnecessary costs to the system on purpose, for example:
- Loaning an AHCCCS card or the information on it to someone else
- Selling an AHCCCS card or the information on it to someone else
Misuse of your AHCCCS identification card, including loaning, selling or giving it to others, could result in your loss of AHCCCS eligibility. Fraud and abuse are felony crimes and are punishable by legal action against the member or provider.
Magellan of Arizona has a zero tolerance policy against fraud, waste and abuse perpetrated by Magellan's employees, providers, members and other entities. The Magellan Special Investigations Unit (SIU) is responsible for investigating allegations of fraud, waste and abuse. Magellan's SIU maintains a toll-free fraud hotline, (800) 755-0850, for the reporting of suspected fraud, waste and abuse. In addition, the SIU accepts referrals via e-mail at SIU@MagellanHealth.com. Referrals can be made anonymously but should include enough detail to support the allegation including member and provider names and addresses, date(s) of service, claim number(s), a description of the allegation and any other details available.
If you think somebody is committing fraud or abuse, contact:
- Magellan's Special Investigations Unit at (800) 755-0850 or by e-mail at SIU@MagellanHealth.com
- ADHS/DBHS Office of Program Integrity at (602) 364-3758 or (866) 569-4927
- AHCCCS Member Fraud Line at (602) 417-4193 or (888) 487-6686