Medicaid Fraud and Patient Abuse Unit

The Medicaid Fraud Control and Patient Abuse Unit enforces the laws pertaining to fraud in the state Medicaid program and prosecutes cases of abuse, neglect or mistreatment of patients in all state healthcare facilities. The Unit prosecutes criminal activity, pursues civil remedies where appropriate and participates with federal and state authorities in a variety of inter-agency investigations and administrative proceedings. Unit prosecutors, auditors, investigators and health care professionals employ a multi-disciplinary approach to combat health care fraud and patient abuse.

In 2013, the Unit recoverd more than $8.1 million for the State's Medicaid budget.

In 2013, the Unit recovered more than $8.1 million for the state’s Medicaid budget, including $6,781,156 from global settlements with pharmaceutical companies for off-label marketing and other offenses, $57,866 in restitution of the medical assistance fraud investigations, $23,478 in criminal case recoveries, $1,276,530 in civil recoveries and $12,500 in investigative costs.

The Unit continues to focus on home health care fraud. Recognizing this area to be a major source of abuse nationwide, the Unit has taken steps to stem the tide of fraud in Rhode Island. The Unit conducts several trainings for fiscal intermediary agencies involved in administering personal care attendant services and work with the Executive Office of Health and Human Services (EOHHS) as to how to detect fraud. In 2013, EOHHS and the Office of Attorney General signed a memorandum of understanding to facilitate referrals of fraud and abuse cases to the Office for investigation and prosecution.

The Unit also drafted legislation to amend the state’s False Claims Act that was passed in 2013, bringing the State into federal compliance and allows Rhode Island to receive an additional ten percent in recoveries from cases filed under the False Claims Act.

To report Medicaid Fraud, Patient Abuse or Neglect, or Drug Diversion, please call:
(401) 222-2566 or (401) 274-4400 extension 2269