Insurance Fraud Affects Everyone

Fraud happens when someone gives false information on purpose that lets someone get a benefit for which they are not entitled. Billions of dollars are lost to health care fraud each year. That means money is paid for services that may never have been given. It could also mean that the service billed was not the one performed. Fraud by doctors and members threaten our health care system and can harm everyone.

Horizon NJ Health has a toll-free hotline to help stop Medicaid fraud. If you know of health care fraud, call Horizon NJ Health’s Fraud Hotline right away. The hotline, 1-855-FRAUD20 (1-855-372-8320), 1-800-682-9090 (TTY 711), offers a way for anyone - members and doctors - to alert Horizon NJ Health of possible insurance fraud. You can also call the New Jersey Medicaid Fraud Division at 1-888-937-2835. TTY: 1-877-294-4356.

When making a report, please be clear about who you think is committing the fraud, give dates of service or items in question, and tell in as much detail as you can why you believe fraud may have happened. All calls and information are kept private and callers do not have to give their name or any personal information if they do not want to give that information.

Examples of doctor fraud:

  • Forging or changing bills or receipts
  • Billing for services that were not given
  • Giving a patient a false diagnosis to perform tests, surgeries or other treatments that are not needed
  • Billing more than once for the same service

Examples of member fraud:

  • Telling a lie on purpose so you or another person get benefits you or they are not entitled to
  • Loaning or selling your Horizon NJ Health member ID card or information on the card to someone else
  • Forging or changing prescriptions

Misuse of your Medicaid card or Horizon NJ Health ID card could result in you losing your health care benefits. Fraud is also a crime that can be punished by legal action with time in jail.

Ways to help fight Medicaid fraud:

  • Don't be afraid to question your doctor about services or care plans if you think they might not be needed.
  • Keep your Medicaid ID number and Medicaid records in a safe location. Do not give out medical information or share your member ID card with anyone except your doctor or other health care provider.
  • Be conscious of "free" tests, services or medical products offered if you give your Medicaid information. Remember, if it sounds too good to be true, it probably is.
  • Look at your Medicaid Summary Notice when you get it. Make sure you understand all of the items listed, and that all of the services listed were given to you.

If you suspect Medicaid fraud, help protect the Medicaid program and public resources that fund it. Report it right away by calling 1-855-FRAUD20 (1-855-372-8320), 1-800-682-9090 (TTY 711), or call the New Jersey Medicaid Fraud Division at 1-888-937-2835. TTY: 1-877-294-4356.