You Can Stop Fraud, Waste, and Abuse
Health care fraud, waste, and abuse cost taxpayers billions of dollars each year. You can help stop fraud by reporting it.
What is Health Care Fraud?
Health care fraud includes, but is not limited to, intentionally making false statements, misrepresentations or deliberate omissions of material facts from any record, bill, claim or any other form for the purpose of obtaining payment, services, or any type of compensation for health care services for which you are not entitled.
Examples of Fraud
By a Member:
- Lending an Alliance member ID card.
- Pretending to be someone else to obtain services.
- Altering or forging a prescription.
- Concealing assets or income in order to gain coverage.
- Falsifying information in order to obtain narcotic medication.
By a Provider:
- Billing for services, procedures and supplies not rendered, or different from what was rendered to the patient.
- Providing services to patients that are not medically necessary.
- Balance billing a Medi-Cal member for Medi-Cal covered services.
- Unbundling or up-coding procedures.
By a Pharmacy:
- Billing for a brand name prescription when dispensing a generic.
- Dispensing a different medication than what was prescribed.
- Altering the quantity of the prescription without proper documentation.
- Buying back prescription medication for resale.
If you suspect fraud by our health plan, doctors, pharmacies, or members, you can report it:
Alliance Compliance Hotline
For more information, please see How to Report Fraud, Waste, and Abuse.
For more information about compliance, please click here.