Reporting Medicaid Fraud and Abuse

Source: Michigan State

Photo Source: Unsplash,

CALL TOLL-FREE 855-MI-FRAUD (643-7283) SUBMIT AN ONLINE COMPLAINT WRITE TO INSPECTOR GENERAL SEND A LETTER Healthcare fraud and abuse affects all of us. Healthcare fraud significantly impacts the Medicaid program by using up valuable public funds needed to help vulnerable children and adults access health care. Everyone can take responsibility by reporting fraud and abuse. Together we can make sure taxpayer money is used for people who really need help. Examples of Medicaid Fraud

• Billing for medical services not actually performed

• Providing unnecessary services

• Billing for more expensive services

• Billing for services separately that should legitimately be one billing

• Billing more than once for the same medical service

• Dispensing generic drugs but billing for brand-name drugs

• Giving or accepting something of value (cash, gifts, services) in return for medical services, (i. e., kickbacks)

• Falsifying cost reports Or When Someone:

• Lies about their eligibility

• Lies about their medical condition

• Forges prescriptions

• Sells their prescription drugs to others

• Loans their Medicaid card to others Or When a Health Care Provider Falsely Charges For:

• Missed appointments

• Unnecessary medical tests

• Telephoned services

The following information is preferred when reporting suspected fraud or abuse:

• Nature of the complaint

• The names of those involved in the suspected fraud and/or abuse, including their address, phone number, Medicaid identification number, date of birth (for beneficiaries), and any other identifying information if available/applicable

Fighting Fraud Can Pay Up to $1,000 You may be eligible for a reward of up to $1,000 if all of these 7 conditions are met:

1. You must report the suspected fraud directly to the Michigan Department of Health and Human Services' Office of Inspector General (OIG). If you reported the fraud to a Medicaid Health Plan, you must also report the fraud to OIG. The allegation must be specific, not general.

2. The suspected fraud must not have occurred later than six years from the date of the initial report.

3. You are a recipient or an entity providing services to a recipient of a Michigan Department of Health and Human Services program.

4. The suspected fraud must be confirmed as potential fraud by OHSIG and formally referred to the Attorney General - Medicaid Fraud Control Unit (AG MFCU) and accepted as a case for investigation.

5. You are not an excluded individual.

6. The person or organization you're reporting isn't already under investigation by the OIG or the AG MFCU for the suspected fraud.

7. Your report leads to criminal or civil action (or any associated settlement) by the AG MFCU AND the direct recovery of at least $1,000 of State of Michigan Medicaid funds.

The incentive payment will be 10% or $1,000, whichever is less, of the state funds recovered. If multiple individuals qualify for a reward, the reward is shared among them. If you want to know more about the Fraud Incentive Program, call 1-855-MI FRAUD (643-7283) or report online. You must leave full contact information to be eligible for a reward.

How can such practices impact your health? How? Why?

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