Fraud and Abuse
Fraud and abuse significantly impact the Medicaid program by using up valuable dollars necessary to help children and adults access needed health care. Fraud is when a provider submits false or fraudulent claims for payment of health care services. Examples of fraud include:
- Altering and/or falsifying records to match services billed
- Billing for services not actually performed
- Billing for service not covered by Medicaid as a covered service
- Billing for a more expensive service than was actually rendered, known as upcoding
- Changing the billed date of service to match client dates of eligibility
- Deliberately applying for duplicate reimbursement in order to get paid twice
- Inappropriate billing that results in a loss to the Medicaid program
- Providing services which are not necessary
- Billing for services performed by unqualified persons
Fraud and abuse of public programs affects all of us. Everyone can take responsibility to report fraud and abuse. For more information:
Attorney Generals Office's Medicaid Fraud Control Unit - frequently asked questions about Medicaid fraud and how to report
Department of Social Services - reporting suspected Medicaid fraud
