What is Medicaid Fraud?
Medicaid Fraud affects everyone. Although most providers are honest and dedicated to providing quality care to their patients, dishonest medical providers steal millions of dollars each year through fraudulent or abusive practices. Reporting fraud helps our Unit return this money to the system so it can provide a healthcare safety-net to those most in need. The mere suspicion of fraud is enough to make a report.
Examples of Fraud in Health Care:
- Billing for services not rendered or more services than actually performed
- Providing and billing for unnecessary services
- “Upcoding” – billing for a higher level of services than actually performed
- Charging higher rates for services to Medicaid than other providers
- Coding billing records to get more reimbursement
- Misrepresenting an unallowable service on bill as another allowable service
- Falsely diagnosing so Medicaid will pay more for services
Who are “providers”?
Dentists, Physicians, Counselors, Psychiatrist, Psychologists, Podiatrists, Nurses, LNAs, Optometrists, Ophthalmologists, Opticians, Radiologists, Technicians, Ambulance technicians, hospitals, nursing homes and other residential facilities, home care agencies, substance abuse treatment centers, laboratories, personal or home healthcare providers, pharmacies, pharmacists, pharmaceutical companies, medical equipment providers.
Please note MFRAU does not investigate individuals who receive Medicaid services. To report suspected recipient fraud, waste or abuse please contact the Program Integrity Unit at (802) 241-9210 or on their website.