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Fraud, Waste, and Abuse Prevention

Photo Credit: CDC/Debora Cartagena

Photo Credit: CDC/Debora Cartagena

What are Fraud, Waste, and Abuse?

Fraud, waste, and abuse can take several forms; some are obvious and others may not be widely recognized. Click here to review definitions and examples.

Reporting Fraud, Waste, and Program Integrity Related Abuse

You may report suspected cases of fraud, waste, and abuse anonymously. You may also report confidentially without fear of retaliation. Confidentiality will be maintained for the suspect person or entity and the person reporting, and all rights afforded to both providers and members will be reserved and enforced during the investigation process.

The following documents provide summary and explanatory information on Medicaid fraud, waste, and abuse:

You may report in one or more of the following ways:

  • By phone to any of the following hotlines:
    • The Ped-I-Care Fraud, Waste, & Abuse Hotline toll-free at (866) 787-4557 or locally at (352) 627-9300
    • The Florida Medicaid Fraud and Abuse Hotline at (888) 419-3456
    • The Department of Health and Human Services Office of the Inspector General (OIG) at (800) 447-8477
    • The Florida Attorney General’s Hotline for Reporting Medicaid Fraud at (866) 966-7226
  • Online by filling out the Medicaid Fraud and Abuse Complaint Form (to report suspected fraud and abuse in the Florida Medicaid system) at: https://apps.ahca.myflorida.com/InspectorGeneral/fraud_complaintform.aspx
  • By emailing information to pedicarecd@peds.ufl.edu
  • By faxing it to (352) 294-8080, or
  • By mailing it to:
    Ped-I-Care Compliance Department
    1699 SW 16th Avenue, Room 3132
    Gainesville, FL 32608-1153

Reminder: Fraud, Waste, and Abuse Training Requirement

Your organization is responsible for understanding regulatory provisions regarding Fraud, Waste, and Abuse (FWA), as required by your contract with Ped-I-Care, by the Agency for Health Care Administration (AHCA), and by the Centers for Medicare and Medicaid Services (CMMS), in accordance with 42 CFR 422.503, as amended. Completing one of items listed below will ensure compliance with this requirement:

  • Ped-I-Care’s Fraud, Waste, and Abuse Training (available at http://pedicare.peds.ufl.edu/compliance/index.html);
  • Training equivalent to Ped-I-Care’s Fraud, Waste, and Abuse Training that meets the requirements outlined in the Medicare Managed Care Manual Chapter 21 – Compliance Program Guidelines and/or Prescriptions Drug Benefit Manual Chapter 9 – Compliance Program Guidelines; or
  • Fraud, Waste, and Abuse Certification (by enrollment into Parts A or B of the Medicare program) or accreditation as a supplier or DMEPOS by a first tier, downstream, or related entity.

Your organization must be able to provide evidence (including logs/certifications) that training has been conducted as required.