How to report Medicaid Fraud cases
The Medicaid program provides health benefits to low-income families who either have no medical insurance or have inadequate medical insurance. The federal government establishes the general Medicaid guidelines; however the program requirements are established and monitored by each individual state.
Do You Suspect Medicaid Fraud?
Physicians, pharmacists, beneficiaries, and even medical equipment companies can be involved in Healthcare fraud, waste, and abuse. Success in combating healthcare fraud, waste, and abuse is measured not only by convictions, but also by effective deterrent efforts.
How to report Fraud cases:
- Anyone suspecting Medicaid fraud, waste, or abuse is encouraged to report it. The first point should be the Program Integrity contact in the State Medicaid Agency for your individual state.
- TheState By State Fraud and Abuse Reporting Contacts document was last updated October 2014, and includes the contact information for the State Medicaid Agencies (SMA), and the Medicaid Fraud Control Units (MFCU).
- Another reporting option is to visitCMS’ State Contacts Database which requires entering the State, Contact Type, and Organization Type. Lastly, the Office of Inspector General’s (OIG) National Fraud Hotline is:
Or visit their website at: Office of Inspector General – Report Fraud
It is helpful to have as much information as possible to facilitate expeditious investigation of the alleged fraud.
Pertinent information includes:
- Name of Medicaid client
- Client’s Medicaid card number
- Name of doctor, hospital, or other healthcare provider
- Date of service
- Amount of money Medicaid approved and/or paid; and
- A description of the acts that you suspect involve fraud