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Reporting Fraud, Waste and Abuse

Coordinated Care works hard to prevent Fraud, Waste and Abuse. We take reports of inappropriate billing by providers seriously. You can let us know if you suspect Fraud, Waste or Abuse.

“Fraud” means to knowingly get benefits or payments that you are not entitled to. Please let us know if you are aware of someone who is committing Fraud. Some examples of Fraud include:

  • Billing for services that were not performed.
  • Using someone else’s ID card to receive services.
  • Lying on an application.
  • Improper use of transportation services.

“Waste” means ordering too many services that result in excessive costs. Some examples of Waste include:

  • A provider ordering too many tests.
  • A provider billing using the wrong codes. 

 

“Abuse” means billing practices resulting in excessive costs, such as:

  • A provider performing services that are not needed.
  • A member seeking services that are not needed.
  • A member seeking prescriptions from different providers and pharmacies to obtain more than is appropriate or needed.

There are many ways to report fraud and abuse:

  • Call Coordinated Care Member Services 1-877-644-4613 (TTY:711)
  • Coordinated Care
    Compliance Department
    1145 Broadway, Suite 700
    Tacoma, WA 98402
  • You may also call our Fraud, Waste & Abuse Hotline: 1-866-685-8664.

The Fraud, Waste & Abuse Hotline is available 24 hours a day, 7 days a week. 

If you see something wrong, please make sure to let us know.

To report waste, abuse, or fraud, gather as much information as possible.

When reporting about a provider (a doctor, dentist, counselor, etc.) include: 

  • Name, address, and phone number of provider
  • Name and address of the facility (hospital, nursing home, home health agency, etc.)
  • Medicaid number of the provider and facility, if you have it
  • Type of provider (doctor, dentist, therapist, pharmacist, etc.)
  • Names and phone numbers of other witnesses who can help in the investigation
  • Dates of events 
  • Summary of what happened

When reporting about someone who gets benefits, include: 

  • The person’s name
  • The person’s date of birth, Social Security Number, or case number if you have it 
  • The city where the person lives 
  • Specific details about the waste, abuse, or fraud