Fraud, waste and abuse

Some people look for illegal ways to get money from health insurance companies. That's called health care fraud and abuse. Experts estimate that it costs you and all U.S. taxpayers as much as $175 billion each year.

Know the signs of fraud and abuse

Fraud

Health care fraud is when someone lies to get money they aren't entitled to. Examples include:

  • A doctor bills the insurance company for a service that the doctor did not provide
  • A person receives health care services under someone else’s name

Abuse

Health care abuse is when a doctor provides unnecessary care or patients try to avoid paying their share of the costs. Health care abuse happens when, for example:

  • A person goes to the emergency room for non-emergency services
  • A doctor orders tests or services you don’t need

What to do if you suspect fraud and abuse

If you think you know of this kind of activity, you should report it by doing one of the following. You won't have to give your name, address or phone number. If you suspect fraud, waste or abuse, please contact us in the way that’s most convenient for you:

Contact Priority Health

  • Call Customer Service at 616.464.8102 or 888.975.8102 (TTY users call 711)
    Monday - Thursday 7:30 a.m. - 7 p.m., Friday 9 a.m. - 5 p.m., Saturday 8:30 a.m. - noon
  • Write:
    Priority Health Fraud and Abuse Program MS 3175
    1231 E. Beltline NE
    Grand Rapids, MI 49525
  • Send an email to SIU@priorityhealth.com

Call the Compliance Helpline

  • Call 800.560.7013 (TTY users call 711). This third-party organization is open 24 hours a day and they'll report your concern to us.

Contact the State of Michigan

  • Call 855.MI.FRAUD (855.643.7283), TTY users call 711
  • Visit michigan.gov/fraud and click on Submit an online complaint
  • Write:
    Office of Inspector General
    P.O. Box 30062
    Lansing, MI 48909