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 plan is intended to impart 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 suppliers and Medicaid recipients abuse the system by engaging in an assortment of scams.

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 must report it immediately. Below are many forms of Medicaid abuse that you should be on the lookout for.

Medicaid Recipient Fraud

Most people receiving Medicaid services do so legally within Medicaid guidelines. However, a small group of folks abuse their rights and participate in deceptive behavior. The agency responsible for investigating Medicaid recipient use and other claims of fakery is the U.S. Health Department's Office of Medicaid Management. There are types of fraud, like prescription drug forgery, that if found during their investigations, the Office of Medicaid Management will turn over to other agencies for follow up and prosecution.

Cases of Medicaid Recipient Fraud

Medicaid user fraud comes is a few different flavors and isn't always obvious. That's why both providers and users need to be conscientious and work together to identify fraudulent activity. Examples of Medicaid user fraud include:

• The loaning of Medicaid ID cards to others.
• Changing or faking an order or prescription.
• Utilizing more than one Medicaid identification card.
• Deliberately getting conflicting, duplicate or excessive services and/or supplies.
• Selling supplies given by Medicaid to others, instead of using them yourself.

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.

How to Report Recipient Fraud

If you believe a Medicaid user has participated in any of the actions listed above or any other dubious activity, please call 1-877-87FRAUD. You can choose to make your statement anonymously.

Medicaid Provider Fraud

Less prevalent but no less damaging, Medicaid supplier fraud does occur. Again, as in Medicaid user fraud, the agency in charge of Medicaid supplier oversight is the Office of Medicaid Management. They review billing, other supplier actions, investigate any claims that Medicaid suppliers are behaving fraudulently and mete out justice when following through on any legal consequences.

Cases of Medicaid Provider Fraud

As stated above in the Cases of Medicaid Recipient Fraud, provider fraud also comes in several different flavors. And again, is why both users and suppliers must work together to identify any fraudulent activity perpetrated by Medicaid suppliers. Ways to assist the Office of Medicaid Management in identifying fraudulent activity include keeping records on the following items:

• When you received service from a Medicaid professional.
• Where the service took place.
• Who the professional was who provided care to you.
• Which services were given during the visit.
• Any additional services ordered by the provider.

Any services billed that weren't actually provided are considered fraud and need to be reported.

Examples of Medicaid supplier fraud include:

• Services billed yet not given, such as a chest x-ray or lab work.
• Billing sent to both the Medicaid program and a private insurance entity or the Medicaid user.
• Calling for the Medicaid user to come back to the supplier's office, even when it's obvious additional appointments are not necessary.
• Ordering unnecessary services like x-rays, blood work, ultrasounds, etc.
• Incorrect coding, i.e., supplying just a regular office visit but billing for something more.
• Using unauthorized suppliers for the services that only authorized professionals should give and then billing them as if the authorized supplier gave the services.
• Providing a set amount of services based on time and then billing for more time than was really provided, i.e., anesthesia, counseling, etc.
• Adding other family members to bills as receiving services when they didn't.
• Sending in a bill for office visits that didn't actually occur.
• When referring a patient to another supplier, the first provider takes payment from the other supplier, which may include part of the reimbursement paid to the second provider by the Medicaid program.

How to Report Medicaid Provider Fraud

If you believe a Medicaid supplier has participated in any of the actions listed above or any other dubious activity, please call 1-877-87FRAUD. You can choose to make your statement anonymously.

More Medicaid Fraud Information