Frequently Asked Questions

Medicaid Fraud and Abuse Prevention

Below are some questions people often ask about Medicaid.  Click on the questions to see the answers:

I want to report someone who is cheating Medicaid.

Call Medicaid's toll-free fraud hotline at 1-866-452-4930. You do not have to give your name, but please have as much information as possible to help our investigators. It is helpful to know identifying information (name, age, etc), the date or dates that the fraud or abuse occurred and a description of the suspicious or fraudulent activity.

What is fraud?

Fraud is defined as intentional deception or misrepresentation by a person who knows that the deception could result in an unauthorized benefit to themselves or another person. Fraud is dependent upon evidence that must prove intent to misrepresent in order to illegally obtain services, payment or other gains.

What is Medicaid program abuse?

Program abuse means provider practices that result in unnecessary cost to Medicaid, are not consistent with sound financial, business or medical practices, or that result in payment for services which are not medically necessary or that fail to meet professionally-recognized standards for health care.

What are examples of provider fraud or abuse?

Examples of provider fraud or abuse include billing for services or equipment that the patient did not get, charging recipients for services over and above what Medicaid paid, double billing or other illegal billing practices, submitting false diplomas or licenses to qualify as a Medicaid provider, ordering tests, procedures or prescriptions that the patient does not need, rebating or accepting fees or a portion of a fee for a Medicaid referral, failing to repay or make arrangements to pay identified overpayments, and physical, mental, emotional or sexual abuse of a patient.

What are examples of recipient fraud or abuse?

Examples of recipient fraud or abuse include forging or altering a prescription, allowing others to use a Medicaid card to get services, failure to keep a Medicaid card safe, intentionally seeking and receiving excessive drugs, services or supplies, collusion with providers in order to get services or supplies, and providing false information in order to qualify for Medicaid.

Is there a list of suspended Medicaid providers?

A list of all providers who are suspended from the Medicaid program may be found on the Agency's website at Fraud/Abuse Prevention.

Does Medicaid ever call people on the phone and ask for a Medicaid number?

It is against Medicaid's rules to call and ask for bank account or other personal information, or cash payment, over the telephone. Never give this type of information to someone who calls you.

Does Medicaid ever charge a recipient to get a new Medicaid card?

No. Medicaid replaces Medicaid ID cards at no cost to the recipient. If you are asked to pay for a Medicaid card, report the call to the toll-free fraud hotline at 1-866-452-4930.

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