Fraud, Waste and Abuse

What is Fraud, Waste, and Abuse?

Fraud is when someone lies or does something illegal on purpose to get care, give someone else care, or get paid for care that is wrong or was not given.

Examples of Fraud:

  • A provider bills Magellan for services, equipment, or medicine you did not get.
  • A member gives their insurance ID card to someone else to use.

Waste is when someone knowingly or unknowingly gives or gets healthcare that is not needed, or misuses resources related to healthcare.

Examples of Waste:

  • A provider uses the wrong code on a claim
  • A provider orders the same test for a member that another provider ordered.

Abuse is when providers do not follow good financial, business, or care practices. Abuse ends up costing public programs extra money. It can also end up harming a member.

Examples of Abuse:

  • A provider keeps writing prescriptions without checking if a member still needs the medicine. 
  • A provider keeps testing a member for flu when the member shpes not show flu symptoms.

How to Report Fraud, Waste or Abuse

If you think someone is using your or another member’s insurance ID card or is changing what is on a prescription, contact Magellan to report it. If you think a provider is ordering tests you don’t need or billing Magellan or you for services you didn’t get, contact Magellan to report it.

Report suspected fraud, waste, or abuse to Magellan’s Special Investigations Unit (SIU) by:

You can also report your concerns to Magellan’s Corporate Compliance hotline.

The hotline is available 24 hours a day, 7 days a week. An outside vendor receives the calls and callers can remain anonymous. All cases will be investigated and will remain confidential.

  • Call Magellan’s Corporate Compliance hotline at 1-800-915-2108 (TTY 711)
  • Email Magellan’s Corporate Compliance Unit at

You can also report your suspicions to the Idaho Department of Health and Welfare by:

When reporting a provider, include as much information as you can:

  • Name, address, and phone number
  • Name and address of facility
  • Type of provider
  • Names and phone numbers of other witnesses
  • Dates and summaries of events

When reporting a member, include:

  • The person’s name
  • The person’s date of birth, if known
  • The city where the person lives
  • Details about the fraud, waste, or abuse

Even if you do not have all the information, you should still file a report.