Report Fraud, Waste, and Abuse

You play a vital role in protecting the integrity of the Health Insurance Marketplace program in North Carolina. To prevent and detect fraud, waste, and abuse, AmeriHealth Caritas Next works with North Carolina Department of Insurance (NCDOI), members, providers, and law enforcement agencies.

Examples of fraud, waste, and abuse include:

  • When you get a bill or an explanation of benefits (EOB) for health care services you never received.
  • Lack of information in a provider’s health record about you to support services billed.
  • Loaning your Member ID 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:

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
  • Time frame of the allegation(s)
  • 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