Report Fraud, Waste, and Abuse
You play a vital role in protecting the integrity of the Health Insurance Marketplace® program in South Carolina. To prevent and detect fraud, waste, and abuse, First Choice Next SM, a product of Select Health of South Carolina, Inc., works with the South Carolina Department of Insurance, members, providers, and law enforcement agencies.
Examples of fraud, waste, and abuse include:
- Getting a bill or an explanation of benefits (EOB) for health care services you never received.
- There being a lack of information in a provider’s health record about you to support services billed.
- Loaning your health insurance membership card to others for the purpose of receiving health care services, supplies, or prescription drugs.
- Providing false or misleading health care information that affect payment for services.
You can report suspected fraud and abuse in any of the following ways:
- Call the Fraud Tip Line at 1-866-833-9718 or email FraudTip@amerihealthcaritas.com.
- Write to First Choice Next’s Special Investigations Unit at P.O. Box 7318 London, KY 40742.
- Contact the South Carolina Department of Insurance, Fraud Investigation Unit:
- By phone: 1-888-953-7283
- E-mail: FraudDivision@doi.sc.gov
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
- Timeframe 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