Waste, Abuse and Fraud (WAF) Program
Sunshine Health wants you to call us if you think or see a provider is charging you for care that was not given to you. It is a crime and we will take needed actions. Call us at 1-866-796-0530 (TDD/TTY 1-800-955-8770) 8 a.m. to 8 p.m. Monday through Friday. When you call us, we will not ask for your name. We have a program that follows the law. Sunshine Health will take your call about waste, abuse and fraud serious. When you call us, we will listen to what you have to say.
Authority and Responsibility
Sunshine Health is serious about finding and reporting fraud and abuse. One type example of fraud is when Sunshine Health gets billed for a service that is more than the service you received. If you have been a victim of fraud, please contact Sunshine Health. Our staff is here to talk to you about this.
The Bureau of Medicaid Program Integrity at the Agency for Health Care Administration audits and looks into providers suspected of overbilling or defrauding Florida’s Medicaid program, recovers get back overpayments, issues administrative sanctions, and refers cases of suspected fraud for criminal investigation.
To report suspected fraud, waste, abuse, or neglect in the Medicaid, Long Term Care or Florida Healthy Kids programs, please use one of the following avenues:
- AHCA Consumer Complaint Hotline: 1-888-419-3456
- Florida Attorney General’s Office: 1-866-966-7226
- The Florida Medicaid Program Integrity Office: 1-850-412-4600
- Agency for Health Care Administration (AHCA) Medicaid Fraud and Abuse Complaint Form
- Report Insurance Fraud to Florida's Chief Financial Officer
- Fraud, Waste and Abuse Referral Form (PDF)
If you report suspected fraud and your report results in a fine, penalty, or forfeiture of property from a doctor or other health care provider, you may be eligible for a reward through the Attorney General’s Fraud Rewards Program (toll-free 1-866-866-7226 or 850-414-3990). The reward may be up to 25 percent of the amount recovered, or a limit of $500,000 per case) Florida statutes Chapter 409.9203). You can talk to the Attorney General’s Office about keeping your identity confidential and protected.