Fraud, Waste and Abuse
The Department of Health Care Policy and Financing is committed to preventing, identifying, and combating fraud, waste and abuse in the Medical Assistance Program.
- Fraud: an intentional act of deception, misrepresentation, or concealment in order to gain something of value.
- Waste: over-utilization of services (not caused by criminally negligent actions) and the misuse of resources.
- Abuse: excessive or improper use of services or actions that are inconsistent with acceptable business or medical practice.
- Recovery Audit Contractor (RAC) program
- Payment Error Rate Measurement (PERM)
- Deficit Reduction Act 2005 (DRA)
- Screening for Employees and Contractors
Report Suspected Fraud, Waste, and Abuse
- How to report Suspected Fraud, Waste and Abuse
- Provider Termination
- Protocol for Provider Self-Disclosure
- Protocol for Self-Audit