Reporting Fraud, Waste and Abuse

Nebraska Total Care is serious about finding and reporting times that Nebraska Medicaid funds are used in the wrong way. This is called waste, fraud or abuse.

Heritage Health - Nebraska Total Care 

Fraud means a member, provider or other person is misusing state or federally funded program resources.  This could include things like: 

  • Giving someone your member ID card so they can get services under your name
  • Using another person’s member ID card to get services under their name
  • A provider billing for the same services twice
  • A provider billing for services that never happened

Waste is the overuse of services that may result in costs not needed for health care benefits. This includes direct costs and indirect costs. Waste usually results from the misuse of services.

Abuse is actions that may result in unnecessary costs not needed for health care benefits. This includes direct costs and indirect costs. Abuse involves payment for items or services when there is no legal reason for to pay for them.

If you think a provider, member or other person is misusing state or federally funded benefits, please tell us right away. We will take your call seriously.

To report potential fraud, waste, or abuse to Nebraska Total Care, please contact us right way. You do not need to give your name.

To report potential Fraud, Waste or Abuse directly to the State Agency, please use one of the methods below.

Report Suspected Fraud or Abuse by a Provider to:
ago.medicaid.fraud@nebraska.gov
(402) 471-3549 or toll-free at 1-800-727-6432

Report Suspected Fraud by Medicaid Recipients to:
Nebraska Department of Health and Human Services
DHHS.InvestigationsSIU@nebraska.gov
(402) 595-3789

To report fraud, waste, or abuse, 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