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 (for more detailed explanation see the Legal Reference page):

Billing for services not rendered or more services than actually performed

Providing and billing for unnecessary services

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 this Unit does not investigate individuals who receive Medicaid services. To report suspected recipient fraud, please contact the Economic Services Division by phone: 1-800-479-6151, Monday through Friday between 7:45 am and 4:30 pm.

To file a report online, click Medicaid Fraud Report Form.