Report Any Suspected FWA Right Away.
If you think an Oregon Health Plan (Medicaid) provider or member is misusing Medicaid/Oregon Health Plan (OHP) programs and benefits, report any suspected fraud, waste and abuse (FWA) right away.
Some examples of FWA include:
- An OHP member sharing their card with other people who do not qualify for Medicaid;
- An OHP provider:
- Billing inappropriately for financial gain, such as billing for services not rendered; submitting duplicate claims; and upcoding.
- Modifying medical records to support false claims.
- Using unlicensed staff to provide services only covered when provided by licensed staff.
Report Medicaid Provider FWA
A “provider" is anyone who provides health care services for OHP/Medicaid members, such as:
- Physicians
- Home care, personal or direct support workers
- Medical equipment suppliers
- Behavioral health professionals
- Medical transportation
Report Suspected Provider FWA Online
You can also report suspected Medicaid provider FWA to Oregon Health Authority (OHA) in these ways:
Report Medicaid Member Fraud
Mail your complaint to:
ODHS Fraud Investigations Unit
PO Box 14150
Salem, OR 97309
You may also report through ODHS's online portal:
https://odhsfraudreferral.oregon.gov/
Learn More about Medicaid Fraud:
Visit the Oregon Department of Human Services (ODHS) Fraud Reporting website and the Oregon Department of Justice (DOJ) Medicaid Fraud Control Unit website.
You can also contact the Oregon DOJ Medicaid Fraud Control Unit at 971-673-1880 (phone) and 971-673-1890 (fax).
Report Licensed Residential Facilities
To report suspected fraud, abuse or neglect in Medicaid-funded nursing facilities, adult foster homes, residential care facilities, assisted living facilities, homecare workers, and other ODHS-licensed/registered care providers, either:
To Report Fraud or Waste by ODHS|OHA Employees:
- For OHA employees: Call 503-945-5649.
- For ODHS employees: Call 503-945-5608.