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Fraud, waste and abuse 

Aetna Better Health® of Illinois is committed to stopping fraud, waste or abuse. We look to our members and providers to help us with this. You should report fraud, waste or abuse right away if you see it.

What is fraud, waste and abuse?

  • Fraud is when someone lies to get money or services.
  • Waste is when someone uses benefits or services they don’t need.
  • Abuse is someone taking money for services when they aren’t legally entitled to payment.

Who can I call?

To prevent, report and stop fraud, waste and abuse, you can call:

 

Report online

You can also report fraud, waste and abuse online on the Illinois Department of Healthcare and Family Services (HFS) website. Or you can fill out our fraud, waste and abuse form.

Provider fraud

Provider fraud, waste and abuse includes: 

 

  • Falsifying medical records 
  • Prescribing more medication than is medically necessary 
  • Giving more health care services than medically necessary 
  • Billing for services that were not rendered 
  • Billing for items not provided 
  • Billing for professional services when a medical professional did not perform the service 

Member fraud 

Member fraud, waste and abuse includes: 

 

  • Lending, selling or giving a health plan ID card or HealthChoice Illinois Benefits Identification Card (BIC) to someone else 
  • Getting similar or the same treatments or medicines from more than one provider 
  • Going to an emergency room when it is not an emergency 
  • Using someone else’s Social Security number or health plan ID number 
  • Receiving money or gifts in exchange for having medical services 

Also of interest: