Fraud and Abuse Policy

Let's Work Together to Prevent Fraud and Abuse

Fraud and Abuse are two of the reasons health care has become so expensive, now costing into the billions of dollars each year. Health care fraud and abuse cost all of us, for example, by increasing our taxes or health insurance premiums or by taking money away from other important programs.

What are fraud and abuse?

Fraud is when a person gets health care services by being dishonest on purpose, such as by:

  • Using an insurance card that is not theirs;
  • Providing incorrect information, such as their income or the state they live in, on their Medicaid application; or
  • Giving a health care provider their health insurance identification number so the provider can bill for services that weren't delivered.

Abuse is when you ask for or a provider gives you services that are not normal for your condition or that are not medically necessary.

How can you help?

You can help prevent fraud and abuse by:

  • Protecting your personal information
  • Never give your insurance card or ID number to anyone other than a healthcare provider you are seeing for covered services; and
  • Never give your card or your insurance ID number to anyone promising you free items or services or calling or visiting you to sell you anything.

Keeping your Medicaid information current:

  • Notify MassHealth or the Connector Authority if your program eligibility changes;
  • Notify Boston Medical Center HealthNet Plan (BMCHP) if your contact information changes; and
  • Let providers know if you have other insurance or if you are seeking care due to an accident.

Identifying errors or fraud or abuse:

  • Fill out and return to BMCHP any questionnaire you might receive from us asking if you have received certain services.

What should you do if you suspect healthcare fraud or abuse?

You can help by immediately reporting any suspicious behavior related to health care services to the Plan by:

  • Calling our anonymous hotline at 1-888-411-4959
  • Faxing us at 1-866-750-0947
  • Sending an email to
  • Writing us at:

    Boston Medical Center HealthNet Plan
    ATTN: Special Investigations Unit
    529 Main Street, Suite 500
    Charlestown, MA 02129

You will not need to give your name. If you do give your name it will not be shared with any of your health care providers.