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Fraud and Abuse

Your Medicaid benefits are provided to keep you or your family members healthy.  As a Medicaid member, NBHP expects that you will use your Medicaid card and Medicaid benefits in a responsible and legal way. Misusing your Medicaid benefits or Medicaid card can cause serious problems.

It is considered fraud if a member or provider lies so they can:

  • Get a service that has not been approved for the member
  • Get Medicaid benefits they are not entitled to.

Abuse happens if a member causes needless costs to the system, on purpose.  For example:

  • Loaning their Medicaid card to someone else, or giving the information on their Medicaid card to someone to use to get services.
  • Selling their Medicaid card to someone else, or selling the information on the card.

Misuse of your Medicaid card, including loaning, selling or giving it to others could result in you losing your Medicaid or other benefits.  It can cause you to lose your Medicaid eligibility.  Fraud and abuse are felony crimes.  They can result in legal action against the member or the provider.

If you think someone is committing fraud and abuse, you can contact:

  • NBHP Compliance Hotline at 970-347-2328
  • NBHP Compliance Officer at 970-347-2374
  • Colorado Medicaid Fraud unit at 303-866-5431