Fraud, Waste and Abuse
The Department is actively working to combat fraud, waste and abuse.
Fraud includes making a false statement or misrepresenting information to get something that benefits oneself or someone else. There are many forms of fraud.
Examples of actions by Medicaid providers which may be fraud include:
- Billing Medicaid for doctor visits, medical procedures, drugs or supplies that are not provided to a client
- Billing for the same service twice
Examples of actions by Medicaid members which may be fraud include:
- Providing false information on applications in order to receive benefits
- Loaning your Medicaid ID card to others
- Selling or buying a Medicaid card
- Giving or selling medication or medical supplies to someone else
- Forging prescriptions
Waste includes over-utilizing Medicaid services, supplies or equipment, or causing unnecessary costs through carelessness or inefficiency.
Abuse* includes activities that result in unnecessary costs to Medicaid.
*Please note: Report physical or emotional abuse to the police.
How You Can Help
If you suspect Medicaid fraud, waste or abuse, please report it to us immediately.
- Our Benefits Coordination Section recovers money and avoids unnecessary costs
- Our Client Over-utilization Program works to detect and reduce over-utilization of Medicaid services, supplies or equipment
- Our Nursing Facility Section works to detect and reduce fraud, waste and abuse
- Our Program Integrity Section works to detect and recover inappropriate payments to Medicaid providers and to review possible fraud by Medicaid providers
- Our Compliance Section works to reduce fraud, waste, and abuse committed by recipients of our programs