Medicaid Fraud

What is Medicaid fraud?
Medicaid fraud can take many forms. You can avoid being taken advantage of by unscrupulous individuals by watching for the following:

  • Payments (in cash or in kind) in return for Medicaid numbers,
  • Every patient in a group setting receiving the same type of service on the same day,
  • Every patient in a group setting receiving the same type of medical equipment, and
  • Services listed on your medical summary notice that you don’t remember receiving or didn’t need.

What are some examples of provider fraud?

  • Billing for medical services not actually performed, known as phantom billing;
  • Billing for a more expensive service than was actually rendered, known as upcoding;
  • Billing for several services that should be combined into one billing, known as unbundling;
  • Billing twice for the same medical service;
  • Dispensing generic drugs and billing for brand-name drugs;
  • Giving or accepting something in return for medical services, known as a kickback;
  • Bribery;
  • Providing unnecessary services;
  • False cost reports; and
  • Embezzlement of recipient funds.

Tips to Prevent Medicaid Fraud

  • DO NOT give your Medicaid card number to anyone except your doctor, clinic, hospital or other health care provider.
  • DO NOT let anyone borrowyour Medicaid card.  Treat your card the way you treat your credit card.
  • DO NOT ask your doctor or other health care provider for medical care that you do not need.
  • DO NOT sign your name to a blank form.
  • Ask for a copy of everything you sign.  Keep the copy for your records.
  • DO NOT share your Medicaid records or other medical information with anyone except your doctor, clinic, hospital or other health care provider.
  • If you are offered free tests or screenings in exchange for your Medicaid card number, be suspicious. Be careful about accepting Medicaid services when you are told they will be free of charge.
  • DO NOT give your Medicaid card number to anyone or do business with door-to-door or telephone sales people who tell you that services of medical equipment are free.
  • Give your Medicaid identification card only to those who have provided you with medical services.