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Fraud & Abuse Prevention

Health care fraud may involve doctors, pharmacists, therapists, medical equipment companies, and/or members. Fraud makes it hard to pay for the services that members really need.

There are things you can do to help fight fraud and abuse: 

  • Look at your bill carefully to make sure you really received the services Children’s Medical Services Managed Care Plan (CMS Plan) is paying for. Check to see that the date of service is correct.
  • DO NOT give your member card number to anyone except your doctor, clinic, hospital or other health care provider.
  • DO NOT let anyone borrow your member identification card. Treat your card the way you treat your credit card.
  • DO NOT ask your doctor or other health care provider for medical care that you do not need.
  • DO NOT sign your name to a blank form.
  • Ask for a copy of everything you sign. Keep the copy for your records.
  • DO NOT share your records or other medical information with anyone except your doctor, clinic, hospital or other health care provider.
  • If you are offered free tests or screenings in exchange for your member identification card number, be suspicious. Be careful about accepting services or items when you are told they will be free of charge.
  • DO NOT give your Ped-I-Care or Medicaid card number to anyone. DO NOT do business with door-to-door or telephone sales people who tell you that services or medical equipment are free.
  • Give your Ped-I-Care identification card only to those who have provided you with medical services.
  • Never pay for services that you know should be paid for by Ped-I-Care, CMS Plan, or Medicaid.
  • Do not let a medical provider bill for services you have not received.
  • If anyone claims they know how to make Medicaid or CMS Plan pay for health care services or goods that Medicaid usually does not pay for, you should avoid them.
  • If you suspect fraud, report it. Call the Fraud and Abuse Hotline at Ped-I-Care. The number is 1-866-787-4557. You may also call the State Fraud and Abuse Hotline at 1-888-419-3456. You do not have to give your name. Even if you give your name, no one will be told that you made the call. No one can do harm to you or your family for making a call.

Report suspected fraud and abuse privately and without fear of harm to any of the following:

  • The Ped-I-Care Hotline at 1-866-787-4557
  • The Florida Medicaid Fraud and Abuse Hotline at 1-888-419-3456
  • The Department of Health and Human Services Office of the Inspector General (OIG) at 1-800-447-8477
  • The Florida Attorney General’s Hotline for Reporting Medicaid Fraud at 1-866-966-7226
  • Click here to fill out the Medicaid Fraud and Abuse Complaint Form
    • Address for mailing complaint form:
      Bureau Chief, Medicaid Program Integrity
      2727 Mahan Drive, MS #6
      Tallahassee, Florida 32308