Fraud and Abuse

Let's Work Together to Prevent Fraud and Abuse

Fraud and Abuse are when a person misuses health care services or receives payment for health care services dishonestly. Some examples of fraud and abuse are below. These are two of the reasons health care has become so expensive, now costing into the billions of dollars each year.  Health care fraud and abuse cost all of us, for example, by increasing our taxes or health insurance premiums or by taking money away from other important programs.

You can help by immediately reporting any suspicious behavior related to health care services to Well Sense Health Plan or to the Department of Health and Human Services (DHHS).

How to Report Fraud and Abuse

If you suspect Member fraud or abuse contact 

Well Sense Health Plan:

  • Phone:  877-957-1300 option 3 
  • Fraud Hotline:  888-411-4959 
  • Email:  FraudandAbuse@wellsense.org 
  • Fax:  866-750-0947  
  • Mail:
    Well Sense Health Plan
    Attn: Special Investigations Unit
    1155 Elm Street, Suite 600
    Manchester, NH 03101

OR Department of Health and Human Services:

  • Phone: 603-271-9258
  • Toll Free (NH Residents): 800-852-3345, ext. 9258 
  • Fax: 603-271-4472 or 
  • Mail:
    Department of Health and Human Services
    Office of Improvement and Integrity, Special Investigations
    129 Pleasant St., Brown Building
    Concord, NH 03301

If you suspect Provider fraud or abuse contact 

Well Sense Health Plan:

  • Phone:  Customer Care Center at 1-877-957-1300 option 3 or
  • Fraud Hotline:  1-888-411-4959
  • Email:  FraudandAbuse@wellsense.org
  • FAX:  1-866-750-0947
  • Mail:
    Well Sense Health Plan
    Attn: Special Investigations Unit
    1155 Elm Street, Suite 600
    Manchester, NH 03101

OR Department of Health and Human Services:

  • Phone:  603-271-7658
  • Toll Free (NH Residents): 800-852-3345, ext. 7658
  • FAX:  603-271-8113
  • Mail:  
    Department of Health and Human Services
    Office of Improvement and Integrity, Program Integrity Unit
    129 Pleasant St., Thayer Building
    Concord, NH 03301

You will not need to give your name; if you do give your name it will not be shared with any of your health care providers.

What are examples of fraud and abuse?

Examples of health care fraud or abuse by a member are:

  • Providing incorrect information, such as their income or the state they live in, on their Medicaid application;
  • Using an insurance card that is not theirs;
  • Seeing different doctors in order to get prescriptions for drugs;
  • Giving or selling their medications or supplies to someone else; or
  • Giving a health care provider their health insurance identification number so the provider can bill for services that weren’t delivered.

Examples of health care fraud or abuse by a provider are:

  • Running tests or giving treatments you don’t need;
  • Billing for services you didn’t receive;
  • Billing non-covered services under a diagnosis you don’t have so that the service will be covered; and
  • Promising you services for free if you give them your insurance card or ID number. 

How can you help?

You can help prevent fraud and abuse by:

Protecting your personal information:

  • Never give your insurance card or ID number to anyone other than a healthcare provider you are seeing for covered services;
  • Don’t give your information to anyone promising you free items or services or calling or visiting you to sell you anything.

Keeping your Medicaid information current:

  • Notifying DHHS if your program eligibility changes;
  • Notifying Well Sense if your contact information changes; and
  • Letting providers know if you have other insurance or if you are seeking care due to an accident.

Identifying errors or fraud or abuse:

  • Filling out and returning to Well Sense any questionnaire you might receive from us asking if you have received certain services; and
  • Filling out and returning to DHHS any questionnaire you might receive asking if you have been in an accident or had an injury.
See our full Fraud and Abuse policy.

Contact Us

woman holding cell phone

Well Sense Member Services

877-957-1300
711 (TTY/TDD for hearing impaired)

Hours: 8 a.m.-8:00 p.m. M-W, 8 a.m.-6 p.m. Th-F