[Skip to Content]

Fraud and Abuse

 

Welcome to the fraud, waste and abuse web page.

We ask that anyone who suspects fraud, waste or abuse report it. We have included the definitions of fraud, waste and abuse so you will know the type of information to report.

Fraud: Intentionally submitting false information to the government or a government contractor to get money or a benefit. Fraud, in other words, is doing something wrong, and sometimes illegal, to bring money or favors to a healthcare organization.

Waste: Overutilization of services or other practices that directly or indirectly result in unnecessary costs to healthcare programs, such as Medicaid or Medicare.

Abuse: Actions, although unintentional, which may directly or indirectly result in unnecessary costs healthcare programs, such as Medicaid or Medicare. In healthcare, abuse may include things such as poor business practices that may increase the price of services or getting paid for services that are not high quality or that someone really did not need.

Some particular activities that are high risks for Fraud, Waste, and Abuse violations include the following:

  • Submitting a false claim that a provider uses to receive payment for a service;
  • Submitting a claim for a service that did not occur;
  • Using the wrong billing code in order to be paid more;
  • Billing for a longer period of time than was actually spent delivering the service;
  • Billing for a service that really was not needed;
  • Taking or giving bribes, which could be money or gifts, so the provider will get more business or other favors;
  • Paying someone so they will give you more business or individuals to serve;
  • Submitting a claim with inadequate or poor documentation to support the service that was billed; or
  • Making up a record to pretend that a service or treatment was provided, even though it was not.


Report Potential Fraud

  • Beacon Health Options:

    Report By Mail:
    Beacon Health Options
    Attn: Compliance Officer
    229 Peachtree Street, NE
    18th floor
    Atlanta, GA 30303

    Report By Phone:
    888-293-3027
    Additional numbers TBD

    Report By E-mail:
    TBD

  • Georgia Office of Inspector General:

    Report By Mail:
    Office of Inspector General
    ATTN: Special Investigations Unit
    2 Peachtree Street, NW 5th Floor
    Atlanta, GA 30303

    Report By Phone:
    404-463-7590
    800-533-0686

    Report By E-mail:
    oiganonymous@dch.ga.gov or
    ReportMedicaidFraud@dch.ga.gov or
    Report fraud using online form.

Compliance Policies and Procedures

  • Georgia Compliance and Program Integrity Plan (Under Review)
  • Beacon Health Options Program Integrity Plan (Under Review)
  • Beacon Health Options FWA Investigation Policy (Under Review)

Laws and Regulations


Program Integrity Links


In the News