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Fraud, Waste, and Abuse

IlliniCare Health is committed to preventing, reporting, and stopping suspected cases of fraud, waste, and abuse. We look to our members and providers to help us with this. If you witness, are told of, or suspect fraud, waste, or abuse, it is important to report it immediately.

Fraud: Intentional deception or misrepresentation to obtain the money or property of a health care benefit program (by means of false or fraudulent pretenses, representations, or promises).

Waste: The over-utilization of services or other practices that result in unnecessary costs.

Abuse: Obtaining payment for items or services when there is no legal entitlement to that payment, but without knowing and/or intentional misrepresentation of facts to obtain payments.

What can you do to help prevent, report, and stop Fraud, Waste, and Abuse?

  • IlliniCare Health Provider Services: 866-329-4701
  • Office of Inspector General: 800-368-1463
  • Department on Aging: 866-800-1409
  • Senior Help Line: 800-252-8966
  • Department of Public Health: 800-252-4343

To report any suspected fraud, waste, or abuse by calling Member Services at 866-329-4701. Or call our Fraud and Abuse hotline at 866-685-8664.

You can report abuse or fraud via the Report Fraud form on the Illinois Department of Healthcare and Family Services' website.

All information will be kept private. Eliminating fraud, waste, and abuse will provide more time and money for your healthcare needs.

If you have questions, call Member Services at 866-329-4701 (TTY: 711).