How to Report Medicaid Fraud

Medicaid fraud is a serious crime that costs the states billions of dollars each year. The fraud and abuse are so upsetting because it diverts funds that could and should be used to help people who cannot afford the proper medical attention they need. Direct Care Innovations (DCI) creates healthcare business management platforms for providers and government agencies in the Medicaid market. Our software offers compliant billing and authorization management, so we understand the importance of fraudulent Medicaid practices. In fact, it is important for everyone to understand the importance of this crime and how to report Medicaid fraud when you are aware of it.

What Is Medicaid Fraud and Who Should Report It?

Medicaid fraud is the act of lying in order to obtain unauthorized Medicaid benefits. There are 3 main types of Medicaid fraud:

• Provider Fraud
• Patient Fraud
• Insurer Fraud

Common types of Medicaid fraud include billing for services not performed, falsifying a diagnosis, providing false information for services, selling prescribed medications, denying valid claims, and misleading enrollees about health plan benefits. Medicaid fraud is not acceptable and should be reported by anyone who witnesses it. Reporting suspected fraud is crucial to the well-being of those in the Medicaid program. If you do not report the fraud, there is a risk of potential harm.

Why Report Medicaid Fraud

Medicaid provides health benefits to low-income families who don’t have proper medical insurance. The federal government establishes the general Medicaid guidelines, but the Medicaid program requirements are set and monitored by each state. It is important to know how to report Medicaid fraud. When you don’t report Medicaid fraud, those that commit these crimes cannot be held accountable and continue to abuse the system.

How to Report Medicaid Fraud

Anyone who suspects Medicaid fraud, abuse, or waste is encouraged to report it.  Here’s how to report fraud:

• Contact the Program Integrity manager at the State Medicaid Agency in your state. You can find your state contact here.
• You may also contact the U.S Department of Health & Human Services to file a fraud complaint. The U.S. Office of the Inspector General (OIG) has a National Fraud Hotline. You can report fraud at 1-800-HHS-TIPS (1-800-447-8477) or you can file a complaint online here.

Important Details

It is helpful to have as many details as possible about the suspected Medicaid fraud. Please have this information available when filing a complaint:

• Name of Medicaid client
• Medicaid card number
• Information about who is providing services or care
• Date of service
• Amount of money Medicaid approved and/or paid; and
• A description of the acts that you suspect involve fraud

At Direct Care Innovations (DCI) we create business management platforms for providers and government agencies in the Medicaid, Medicare, private insurance and managed care markets to help prevent Medicaid fraud.  The team at DCI understands the seriousness of Medicaid fraud and works hard for those in our care. If you are a provider or work for a government agency, DCI can help your company. Contact us today to learn more about SCI or to schedule a free, no obligation sales demo of our software.