Medicaid Fraud Steals from Everyone
Medicaid Scams steal money from those that need it most, both patients and the people that provide health care services.
 The Medicaid program is intended to provide health care to the poor by using tax dollars to pay the medical bills
of low-income people. Receiving these funds is life or death for many Americans the hope is that the money is managed
wisely so that the most good reaches the most people. Sadly, some Medicaid providers and Medicaid recipients abuse
the system by engaging in various forms of fraud.
What Medicaid Fraud Does
Medicaid Fraud has far-reaching effects that touch almost everyone whether it's the people in need of health care, honest
providers of health care and then finally you the taxpayer. Every time a patient files a claim fraudulently and each time
a provider bills more than they should they are taking money away from those that need it. If you know anyone defrauding
the Medicaid system you should report it immediately. Below are many forms of Medicaid abuse that you should be on the
lookout for.
Medicaid Recipient Fraud
A small percentage of recipients engage in fraudulent behavior and abuse their Medicaid privileges. The Health Department's
Office of Medicaid Management reviews recipient utilization and investigates other charges of fraudulent behavior in order
to take appropriate actions. Some types of recipient fraud, such as forging prescriptions, are subject to prosecution and
will be referred to the appropriate authorities.
Examples of Medicaid Recipient Fraud
Medicaid recipient fraud can take several forms and we need the cooperation of diligent providers and Medicaid recipients
to uncover this type of activity. Among the kinds of actions that constitute recipient fraud are:
- Loaning his/her Medicaid Identification card to another person
- Forging or altering a prescription or fiscal order
- Using multiple MA ID cards
- Intentionally receiving duplicative, excessive, contraindicated or conflicting health care services or supplies
- Re-selling items provided by the Medicaid program.
- How to Report Recipient Fraud
If you suspect that a recipient has engaged in any of the activities listed above or any other questionable activity, please
call 1-877-87FRAUD. Your call will remain confidential.
Medicaid Provider Fraud
A small number of Medicaid providers engage in fraudulent activities. The Office of Medicaid Management reviews provider
billing and other activities and investigates charges of fraudulent behavior in order to take appropriate actions.
Examples of Medicaid Provider Fraud
Medicaid provider fraud has many forms and we need the cooperation of diligent providers and Medicaid recipients to uncover
this type of activity. One way for a recipient of medical services to assist us in identifying fraud is to keep a record of the following:
- When a professional service is used
- Where the service takes place
- Who takes care of you
- What services are provided during the visit
- What additional services were ordered by the provider.
If a recipient suspects that a provider has billed Medicaid for more services than were actually provided, that would be fraud.
Some examples of Medicaid provider fraud include:
- Billing for services that were not provided, e.g., a chest x-ray that was not taken.
- Duplicate billing which occurs when a provider bills Medicaid and also bills private insurance and/or the recipient.
- Requiring the recipient to return to the office for more visits when another appointment is not necessary.
- Taking unnecessary x-rays, blood work, etc.
- Upcoding, e.g., providing a simple office visit and billing for a comprehensive visit.
- Having an unlicensed person perform services that only a licensed professional should render, and bills as if the professional provided the service.
- Billing for more time than actually provided, i.e., counseling, anesthesia, etc.
- Billing for an office visit when there was none, or adding additional family members' names to bills.
- Accepting payment from another provider, including sharing in the reimbursement paid by the Medicaid program, as a result of referring a patient to the other provider.
How to Report Medicaid Provider Fraud
If you suspect that a provider has engaged in any of the activities listed above or any other questionable activity, please call 1-877-87FRAUD.
Your call will remain confidential.
More Medicaid Fraud Information
Some Examples of Medicaid Fraud
How to Help Fight Medicaid Fraud
Common Medicaid Scams
Hospices/Nursing Homes: Medicare/Medicaid Fraud Alert
Hospice Fraud & Scams You May Encounter
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