Fraud, Waste & Abuse
As a Magellan provider, the services that you offer our members are subject to both federal and state laws and contract requirements designed to prevent fraud, waste and abuse in government programs (such as Medicare and Medicaid) and private insurance. You can find definitions, examples and ways to prevent fraud in Magellan’s fraud, waste and abuse FAQs.
The most serious violation in this category is healthcare fraud, which is the intentional deception or misrepresentation made by an individual, knowing that the misrepresentation could result in some unauthorized benefit to them or to others. The most common kind of healthcare fraud involves false statements or deliberate omission of information that is critical in the determination of authorization and payment for services. Healthcare fraud can result in significant monetary liabilities and, in some cases, subject the perpetrator to criminal prosecution.
We have a comprehensive compliance program in place, including policies and procedures to address the prevention of fraud, waste and abuse. Magellan, in conjunction with appropriate government agencies, actively pursues all suspected cases of fraud, waste and abuse.
If you think you have detected an instance of either healthcare fraud or medical identity theft, please contact our Special Investigations Unit (SIU) through our 24-hour Fraud Hotline at 1-800-755-0850 or by email at SIU@MagellanHealth.com.