Report Fraud, Waste, and Abuse

You play a vital role in protecting the integrity of the Health Insurance Marketplace program in Florida. To prevent and detect fraud, waste, and abuse, AmeriHealth Caritas Next works with the Florida Department of Insurance, members, providers, and law enforcement agencies.

Examples of fraud, waste, and abuse include:

  • A provider sending a bill or an explanation of benefits (EOB) for health care services you never received.
  • The provider's health record not having  enough information in your health record about you to support the services billed.
  • Loaning your health insurance member ID card to others for the purpose of receiving health care services, supplies, or prescription drugs.
  • Providing false or misleading health care information that affects payment for services.

You can report suspected fraud, waste, and abuse in any of the following ways:

  • Call the AmeriHealth Caritas Next Fraud Tip Line at 1-866-833-9718 or email FraudTip@amerihealthcaritas.com.
  • Write to AmeriHealth Caritas Next’s Special Investigations Unit at P.O. Box 7318 London, KY 40742.
  • Contact the Florida Department of Insurance, Fraud Investigation Unit:

Below are examples of information that will assist with the investigation:

  • Contact information (e.g., name of individual making the allegation, address, phone number)
  • Description of the alleged fraudulent or abusive activities
  • Time frame of the alleged activities
  • Name and identification number of the suspected individual
  • Source of the complaint, including the type of item or service involved in the allegation
  • Approximate dollar amounts involved, if known
  • Place of service
For Members