Fraud and abuse significantly impact the Medicaid program by using up valuable dollars necessary to help children and adults access needed health care.; Fraud is when a provider submits false or fraudulent claims for payment of health care services. Examples of fraud include:

  • Altering and/or falsifying records to match services billed
  • Billing for services not actually performed
  • Billing for service not covered by Medicaid as a covered service
  • Billing for a more expensive service than was actually rendered, known as upcoding
  • Changing the billed date of service to match client dates of eligibility
  • Deliberately applying for duplicate reimbursement in order to get paid twice
  • Inappropriate billing that results in a loss to the Medicaid program
  • Providing services which are not necessary
  • Billing for services performed by unqualified persons

Fraud and abuse of public programs affects all of us. Everyone can take responsibility to report fraud and abuse. For more information:

Attorney Generals Office's Medicaid Fraud Control Unit - frequently asked questions about Medicaid fraud and how to report

Department of Social Services - reporting suspected Medicaid fraud