What is considered Medicaid fraud?

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Medicaid is a federal- and stated-funded, state-operated health insurance program for certain low-income individuals, including seniors, disabled, pregnant women and children. Medicaid fraud can be reported to your state's Medicaid office.

Types

Types of Medicaid fraud include Medicaid provider fraud, misuse of Medicaid recipient funds and mistreatment of patients in Medicaid facilities.

Identification

Medicaid fraud can be identified by locating any services on your explanation of benefits that were not received, encouragement from providers to receive unnecessary services and unauthorized withdrawals from Medicaid funds if you are living in a nursing home.

Billing

Medicaid billing fraud includes billing for services that are not received, collecting payments for nonexistent patients, billing for used medical equipment as if it were new equipment, billing for unnecessary services, billing for services provided by unlicensed individuals, accepting kickbacks for services and billing long periods of time for counseling sessions much shorter in duration.

Providers

Providers must be approved by Medicaid to accept payments. If you are unsure whether a provider is Medicaid approved, contact your state's Medicaid office.

Criminal Convictions

Certain criminal convictions exclude individuals from collecting Medicaid payments. If your Medicaid provider is convicted of a crime, contact your state's Medicaid office to determine whether the provider is still allowed to collect payments.

Source:

Indiana Attorney General: Medicaid Fraud

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What is considered Medicaid fraud?

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