Report Fraud, Waste and Abuse

Reporting Abuse & Neglect

If you or one of your staff members witnesses, is told of, or suspects an incident of abuse or neglect, it is important to report the allegation immediately.

Ways to Report Abuse & Neglect:

  • IlliniCare Health Provider Services: 1-866-329-4701
  • Office of Inspector General: 1-800-368-1463
  • Department on Aging: 1-866-800-1409
  • Senior Help Line: 1-800-252-8966
  • Department of Public Health: 1-800-252-4343

Types and definitions of abuse and neglect:

  • Neglect. When an individual fails to provide or withhold the necessities of life,including, but not limited to, food, clothing, shelter, or medical care.
  • Abuse. Causing any physical, sexual or mental injury to an individual, including exploitation of the individual’s financial resources.
  • Bodily harm. Any injury, damage or impairment to an individual’s physical condition,or making physical contact of an insulting or provoking nature with an individual.
  • Mental abuse. The use of demeaning, intimidating or threatening words, signs,gestures or other actions about an individual and in the presence of an individual or individuals that results in emotional distress or maladaptive behavior, or could have resulted in emotional distress or maladaptive behavior, for any individual present.
  • Physical abuse. Non-accidental and inappropriate contact with an individual thatcauses bodily harm.
  • Sexual abuse. Any sexual behavior, sexual contact or intimate physical contact,including coercion or encouragement of an individual to engage in sexual activity that results in sexual contact, intimate physical contact, sexual behavior or intimatephysical behavior.
  • Financial Abuse. Using an individuals financial resources without consent. This includes improper use of guardianship or power of attorney.

Guidelines to Reporting Abuse & Neglect

Within four hours after the initial discovery of an incident of alleged physical abuse, sexual abuse, mental abuse, financial exploitation or neglect, the required reporter shall report the following allegations by phone to the Office of Inspector General hotline:

  • Physical, sexual or mental abuse
  • Neglect by an employee, community agency or facility
  • Financial exploitation by an employee, community agency or facility
  • Injury or death of an individual that occurs within a facility or community agency program when abuse or neglect may be suspected

Below is the information required when reporting Abuse & Neglect. Please note that it is not a violation of HIPPA to give information in the case of abuse or neglect.

  • Information about the victim, including name, date of birth, sex, disability, identification number and/or social security number
  • Information about the incident, including what happened, when it happened, where it happened, how it happened and the identification of all witnesses
  • Information about the accused (if known), including name, contact information and if the accused is presently working with or will be working with the alleged victim
  • Information about the person initiating the complaint, including name, contact information, relationship to the victim and the need for anonymity (if applicable)

Reporting Fraud

Fraud means to knowingly get benefits or payments to which you are not entitled. Please let us know if you are aware of someone who is committing fraud under the Medicaid program. This could be a provider or a member.

Some examples of fraud and abuse include:

  • A lie on an application
  • Using someone else’s ID card
  • A provider (doctor) billing for services that were not done
  • Transportation (usage abuse)

You can report any suspected areas of fraud or abuse to us by calling member services at 1-866-329-4701. You can also use our Fraud and Abuse hotline at 1-866-685-8664. You can also report abuse or fraud online by clicking here. All information will be kept private. Eliminating fraud and abuse will provide more time and money for your healthcare needs.