Report Fraud, Waste, and Abuse
You play a vital role in protecting the integrity of the individual and family health plans we offer in Delaware. To prevent and detect fraud, waste, and abuse, AmeriHealth Caritas Next works with the Delaware Department of Insurance, members, providers, and law enforcement agencies.
Examples of fraud, waste, and abuse include:
- Getting a bill or an explanation of benefits (EOB) for health care services you never received.
- There being a lack of information in a provider’s health record about you to support services billed.
- Loaning your health insurance membership card to others for the purpose of receiving health care services, supplies, or prescription drugs.
- Providing false or misleading health care information that affects payment for services.
You can report suspected fraud and abuse in any of the following ways:
- Call the AmeriHealth Caritas Next Fraud Tip Line at 1-866-833-9718 or email FraudTip@amerihealthcaritas.com.
- Write to AmeriHealth Caritas Next’s Special Investigations Unit at P.O. Box 7318 London, KY 40742.
- Contact the Delaware Department of Insurance, Fraud Investigation Unit:
- By phone: 1-800-632-5154 (toll-free 1-302-674-7350)
- By mail: Fraud Prevention, 1351 West North Street, Suite 101, Dover, DE 19904
- E-mail: firstname.lastname@example.org
Below are examples of information that will assist with the investigation:
- Contact information (e.g., name of individual making the allegation, address, phone number)
- Description of the alleged fraudulent or abusive activities
- Timeframe of the alleged activities
- Name and identification number of the suspected individual
- Source of the complaint, including the type of item or service involved in the allegation
- Approximate dollar amounts involved, if known
- Place of service